Alternative Bearing Couples in Total Hip Replacements: Solutions for Young Patients

2003 ◽  
Vol 13 (2_suppl) ◽  
pp. 31-35 ◽  
Author(s):  
J. Fisher ◽  
E. Ingham ◽  
M.H. Stone
Keyword(s):  
Polyethylene Wear ◽  
Young Patients ◽  
Volumetric Wear ◽  
Wear Rates ◽  
Total Hip Replacements ◽  
Metal On Metal ◽  
Hip Replacements ◽  
Gamma Irradiated ◽  
Ceramic On Ceramic

There is now considerable clinical concern about the effect of polyethylene wear debris induced osteolysis in long term failure of hip replacements. This paper compares the wear of stabilised and crosslinked polyethylene to alternative hard on hard bearings. The volumetric wear rates of stabilised and moderately crosslinked polyethylene 50 to 35 mm3/million cycles were less than previously reported for historical gamma irradiated in air polyethylene, but still of a level that in the long term could cause osteolysis. The moderately crosslinked polyethylene produced less wear than non-crosslinked polyethylene, but particles were smaller and more reactive resulting in little change in the osteolytic potential. Alumina ceramic on ceramic produced substantially less wear and osteolytic potential. Metal on metal also produced less wear than polyethylene but the particles adversely influence cell viability.

Analysis of the Factors that Predispose to Wear with a 32mm Femoral Head at 5–15 Year follow-up: Clinical and Radiographic Assessment of the Harris-Galante cup at 5–15 Year follow-up

2003 ◽  
Vol 13 (2) ◽  
pp. 65-73
Author(s):  
M. Katsimihas ◽  
G. Katsimihas ◽  
M.B Lee ◽  
I. D. Learmonth
Keyword(s):  
Wear Rate ◽  
Polyethylene Wear ◽  
Young Patients ◽  
Harris Hip Score ◽  
Linear Wear ◽  
Outer Diameter ◽  
Linear Wear Rate ◽  
Total Hip Replacements ◽  
Hip Replacements

The clinical and radiographic features of 109 consecutive hybrid total hip replacements performed between 1986 and 1992 in 96 patients were retrospectively reviewed. A cementless Harris-Galante (HGP1) cup and a 32mm monobloc straight Muller stem were used in all cases. At an average 10.11 (range 5 to 15) years following surgery, the excellent durability of fixation of the Harris-Galante cup has been demonstrated with only one cup (0.9%) revised for periacetabular osteolysis and aseptic loosening. The prevalence of polyethylene wear was 27.4%. The mean annual linear wear rate was 0.063mm (range 0.00–0.53mm). There was a significantly increased wear of polyethylene inserts with an outer diameter < 52mm (<10mm polyethylene thickness), (ANOVA Test). However, there was no association found between acetabular liner wear and the following factors: underlying diagnosis, Charnley grade, age, weight and sex of the patient. The Harris Hip Score ranged between 5 and 54 pre-operatively and the average HHS was more than 80 post-operatively with more than 70% of patients pain-free. A liner with a thickness of 10mm or greater may prove beneficial in the prevention and reduction of wear rate particularly in young patients. It is recommended that all patients with this cup design, in which a polyethylene insert that is less than 10mm thick is coupled with a 32mm head, should continue to be regularly followed up.

Bearing surfaces

2011 ◽  
Author(s):  
Gordon Blunn
Keyword(s):  
Metal Ion ◽  
Polyethylene Wear ◽  
Ion Release ◽  
Wear Rates ◽  
Metal On Metal ◽  
Metal Ion Release ◽  
Hip Replacements ◽  
Alternative Material ◽  
Catastrophic Fracture ◽  
The 1960S

♦ Traditionally bearings were made from polyethylene and cobalt chrome. These bearings are still most commonly used for knee replacements. In hip replacements due to osteolysis caused by polyethylene wear alternative material combinations at the bearing surface are used♦ Highly cross linked plastics have been developed and have been shown to reduce wear. There are a number of different types available which differ in their performance♦ Metal on metal bearings first used in the 1960s have also been developed and show very low wear rates. These bearings are more susceptible to edge loading and the resulting metal ion release can result in adverse biological reactions leading to failure♦ Whilst ceramic on plastic surfaces have been used for a considerable amount of time the reduction in wear is not as great as with well functioning metal on metal bearings♦ Ceramic on ceramic bearings have been used for a considerable time and show even lower wear rates than metal on metal bearings. In the past there has been an incidence of catastrophic fracture of these bearings but developments in materials technology have considerably reduced these events.

The ethylene oxide sterilised Opera acetabular component demonstrates high rates of loosening and revision compared to the gamma irradiated Ogee cup: a cohort study demonstrating potential shortcomings of revision-based registry data

2021 ◽  
pp. 112070002110189
Author(s):  
Kwaku W Baryeh ◽  
Kate Bennett ◽  
David H Sochart
Keyword(s):  
Ethylene Oxide ◽  
Total Hip Replacements ◽  
Hip Replacements ◽  
Long Term Follow Up ◽  
Gamma Irradiated ◽  
Acetabular Implant ◽  
Acetabular Components ◽  
Ultra High Molecular Weight

Aims: To evaluate the long-term clinical outcomes of 2 cemented ultra-high molecular weight polyethylene (UHMWPE) acetabular components, with the main difference between the 2 components being their method of sterilisation. Patients and methods: Data was collected prospectively on 352 consecutive total hip replacements, performed between March 2000 and July 2004, at a single centre. A posterior approach was used with a cemented C-Stem femoral component (DePuy, Warsaw, IN, USA) in all cases and either the Ogee (DePuy, Warsaw, IN, USA) or the Opera (Smith & Nephew, Memphis, TN, USA) acetabular implant. Patients were reviewed clinically and radiologically with a median 12-year follow-up (6–16 years). Results: The risk of experiencing loosening was 90% lower for the Gamma irradiated implant (GII) group compared to the ethylene oxide sterilised implant (EOSI) group, which was statistically significant ( p = 0.003), (HR 0.10; 95% CI, 0.02–0.45). The incidence of cup revision was also lower in the GII group ( p = 0.029), but after adjustment for age, gender and BMI was not statistically significant ( p = 0.104). 15-year survivorship with failure/loosening as an endpoint was 70.1% for the EOS implant and 92.9% for the GII (OR 4.99; CI 95%, 1.75–14.2) and with revision as an endpoint was 81.4% for the EOSI and 92.9% for the GII (OR 2.60; CI 95%, 0.87–7.75) Conclusions: We report increased rates of loosening, revision and failure for the EOSI compared to the GII at long-term follow-up. This may have been attributable to the different sterilisation methods used.

SURVIVORSHIP AND RETRIEVAL ANALYSIS OF SIKOMET METAL-ON-METAL TOTAL HIP REPLACEMENTS AT A MEAN OF SEVEN YEARS

2006 ◽  
Vol 88 (6) ◽  
pp. 1173-1182 ◽  
Author(s):  
INGRID MILOŠEV ◽  
RIHARD TREBŠE ◽  
SIMON KOVAČ ◽  
ANDREJ CÖR ◽  
VENČESLAV PIŠOT
Keyword(s):  
Total Hip ◽  
Retrieval Analysis ◽  
Total Hip Replacements ◽  
Metal On Metal ◽  
Hip Replacements

ACCURACY OF MEASUREMENT OF POLYETHYLENE WEAR WITH USE OF RADIOGRAPHS OF TOTAL HIP REPLACEMENTS

2003 ◽  
Vol 85 (12) ◽  
pp. 2378-2384 ◽  
Author(s):  
EDWARD EBRAMZADEH ◽  
SOPHIA N. SANGIORGIO ◽  
FEDERICO LATTUADA ◽  
JOON-SOON KANG ◽  
ROBERTO CHIESA ◽  
...  
Keyword(s):  
Polyethylene Wear ◽  
Total Hip ◽  
Total Hip Replacements ◽  
Hip Replacements ◽  
Accuracy Of Measurement

Total hip replacement: modes of failure

2011 ◽  
Author(s):  
Rob Pollock
Keyword(s):  
Aseptic Loosening ◽  
Success Rates ◽  
Total Hip ◽  
Reactive Protein ◽  
Modes Of Failure ◽  
Total Hip Replacements ◽  
Hip Replacements ◽  
Simple Fixation

♦ Total hip replacements (THRs) may fail in various ways. They may become infected, they may be subject to aseptic loosening, they may dislocate, or a periprosthetic fracture may occur. The patient with a failed THR must be thoroughly assessed before treatment is contemplated♦ Infection may be acute or chronic. Assessment involves clinical assessment, plain radiographs, blood tests (C-reactive protein and erythrocyte sedimentation rate), hip aspiration, and, sometimes, nuclear medicine. The acutely infected hip may be treated with one-stage revision. This involves thorough lavage, debridement, and exchange of all modular components as well as long-term antibiotic therapy. The gold standard of treatment for a chronically infected THR is a two-stage revision. Success rates of 80–90% can be expected♦ Aseptic loosening typically occurs at the cement bone interface in hips where a metal-on-polyethylene bearing couple has been used. Bone resorption takes place as a result of an inflammatory response to small wear particles. After infection has been excluded the treatment of choice is a single-stage revision♦ Dislocation may be the result of patient factors, implant factors, or poor surgical technique. It is imperative for the clinician to minimize the risk by selecting patients carefully, using the correct combination of implants and performing surgery accurately♦ The management of periprosthetic fractures depends on how well the implants are fixed and quality of bone stock. Treatment ranges from simple fixation of the fracture through to revision augmented with strut allograft.

Direct evidence of lubrication in ceramic-on-ceramic total hip replacements

2001 ◽  
Vol 215 (3) ◽  
pp. 265-268 ◽  
Author(s):  
S L Smith ◽  
D Dowson ◽  
A A J Goldsmith ◽  
R Valizadeh ◽  
J S Colligon
Keyword(s):  
Squeeze Film ◽  
Asperity Contact ◽  
Surface Separation ◽  
Total Hip Replacements ◽  
Hip Simulator ◽  
Hip Replacements ◽  
Acetabular Components ◽  
Thin Conducting Film ◽  
Film Lubrication ◽  
Ceramic On Ceramic

A study of surface contact and separation of ceramic-on-ceramic joints was undertaken in 25 per cent bovine serum using a hip simulator. An electrical resistivity technique was used to detect the extent of surface separation throughout a complete walking cycle. The femoral and acetabular components were coated in a thin conducting film of titanium nitride to allow application of the resistivity technique to non-conducting ceramic. Surface separation of the acetabular and femoral components was detected throughout each simulated walking cycle. Fluctuations in the applied voltage across the joint were observed which could not be attributed to elastohydrodynamic or squeeze-film lubrication effects. The probable cause of the voltage fluctuations was brief and occasional contact between the surfaces caused by a combination of asperity contact and subsequent detachment of the conductive coating.

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