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Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Few large series of hard bearing surfaces have reported on reasons for early failure. A number of unique mechanisms of failure, including fracture, squeaking, and adverse tissue reactions, have been reported with these hard bearing surfaces. However, the incidence varies among the published studies.

Questions/purposes

To confirm the incidences, we identified the etiologies of early failures of hard-on-hard bearing surfaces for ceramic-on-ceramic and metal-on-metal THAs.

Methods

We retrospectively reviewed records of 2907 THAs with hard-on-hard bearing surfaces implanted between 1996 and 2009; 1697 (58%) had ceramic-on-ceramic and 1210 (42%) had metal-on-metal bearing surfaces. We recorded bearing-related complications and compared them to nonspecific reasons for revision THA. The minimum followup of the ceramic-on-ceramic and metal-on-metal cohorts was 6 months (mean, 48 months; range, 6–97 months) and 24 months (mean, 60 months; range, 24–178 months), respectively.

Results

The overall revision rate for ceramic-on-ceramic THA was 2.2% (38 of 1697), with aseptic loosening accounting for 55% of revisions (femur or acetabulum). The bearing accounted for 13% of the revisions in the ceramic-on-ceramic THA cohort. The overall metal-on-metal revision rate was 5.4% (65 of 1210), 17 involving adverse tissue reactions related to the metal-on-metal bearing surface (17 of 1210, 1.4% of cases; 17 of 65, 26% of revisions).

Conclusions

Twenty-six percent of the revisions from metal-on-metal and 13% of ceramic-on ceramic were bearing related. The overall short- to medium-term revision rate was 2.2% and 5.4% for ceramic-on-ceramic and metal-on-metal, respectively. The most common etiology of failure was loosening of the femoral or acetabular components.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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Author information

Authors and Affiliations

  1. Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA

    Manny Porat MD, Javad Parvizi MD, FRCS & Peter F. Sharkey MD

  2. Joint Implant Surgeons, Inc, New Albany, OH, USA

    Keith R. Berend MD & Adolph V. Lombardi Jr MD, FACS

  3. Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO, 63110, USA

    Robert L. Barrack MD

Authors
  1. Manny Porat MD
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  2. Javad Parvizi MD, FRCS
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  3. Peter F. Sharkey MD
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  4. Keith R. Berend MD
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  5. Adolph V. Lombardi Jr MD, FACS
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  6. Robert L. Barrack MD
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Corresponding author

Correspondence to Robert L. Barrack MD.

Additional information

No funding was received in support of this study. One or more of the authors (AVL, KRB, RLB) receive research support from Biomet, Inc (Warsaw, IN, USA). One author (RLB) receives research support from BiospaceMed/EOS Imaging (Paris, France), Medical Compression Systems, Inc (West Hills, CA, USA), Smith & Nephew, Inc (Memphis, TN, USA), NIH, and Wright Medical Technology, Inc (Arlington, TN, USA). One author (JP) receives research support from NIH, Orthopaedic Research and Educational Foundation (Rosemont, IL, USA), US Department of Defense (Washington, DC, USA), American Orthopaedic Association (Rosemont, IL, USA), Musculoskeletal Transplant Foundation (Edison, NJ, USA), Stryker Orthopedics (Mahwah, NJ, USA), Ortho-McNeil Pharmaceutical, Inc (Titusville, NJ, USA), Adolor Corp. (Exton, PA, USA), Cubist Pharmaceuticals (Lexington, MA, USA), 3M Co. (St. Paul, MN, USA), Zimmer, Inc (Warsaw, IN, USA), BioMemetic Therapeutics, Inc (Franklin, TN, USA), Wyeth (Madison, NJ, USA), and Canadian Health. One or more of the authors (AVL, KRB) receive royalties and are consultants for Biomet. One author (KRB) is a consultant for Salient Surgical Technologies Inc (Portsmouth, NH, USA). One author (AVL) receives royalties from Innomed, Inc (Savannah, GA, USA). One author (RLB) received royalties from Smith & Nephew in the past 12 months. One author (JP) receives royalties from SmarTech (Philadelphia, PA, USA) and is consultant to Zimmer, Biomet, Smith & Nephew, and Stryker. One author (PFS) receives royalties from Stryker, StelKast Inc (McMurray, PA, USA), and Knee Creations, LLC (New York, NY, USA) and is a consultant for Stryker.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or the device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at The Rothman Institute at Thomas Jefferson University and Joint Implant Surgeons, Inc.

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Porat, M., Parvizi, J., Sharkey, P.F. et al. Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties. Clin Orthop Relat Res 470, 382–387 (2012). https://doi.org/10.1007/s11999-011-2161-y

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  • DOI: https://doi.org/10.1007/s11999-011-2161-y

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