Clinical Orthopaedics and Related Research®

, Volume 470, Issue 11, pp 3094–3100 | Cite as

Alumina Heads Minimize Wear and Femoral Osteolysis Progression After Isolated Simple Acetabular Revision

  • Philippe Hernigou
  • Nicolas Dupuy
  • Olivier Pidet
  • Yashuhiro Homma
  • Charles Henri Flouzat Lachaniette
Symposium: Papers Presented at the 2011 Meeting of the International Hip Society

Abstract

Background

Patients with THA requiring cup revision for acetabular osteolysis may have a stable stem component without loosening. However, it is unclear whether isolated cup revision halts femoral osteolysis progression.

Question/purposes

We asked (1) whether and to what degree osteolysis progresses after isolated acetabular revision with a change of the femoral head and (2) whether an alumina or metal bearing better reduces osteolysis progression and wear with a polyethylene (PE) cup.

Methods

We retrospectively evaluated 150 patients who underwent 165 acetabular revisions but no treatment for proximal femoral osteolysis in hips with stable femoral components. Mean age at revision was 63 years (range, 48–74 years). All hips received a new PE cup; 83 hips received new alumina heads and 82 new metal heads. Radiographs (mean followup, 15 years; range, 10–25 years) were assessed to measure osteolysis, loosening, and PE wear. Revisions of the femoral stem were recorded.

Results

An isolated cup revision with a change of the femoral head halted femoral osteolysis progression for 10 years in 133 hips (81%), with a greater percentage without progression in hips with alumina heads (99% versus 62% with metal head). Alumina heads were better than metal heads at reducing the area of osteolysis progression (47 versus 250 mm2) and wear (0.07 versus 0.14 mm/year) and increasing the survival probability before femoral revision (98% versus 85% at 15 years’ followup).

Conclusions

An isolated cup revision with a new alumina femoral head (in hips that have a stable stem component without loosening) usually halts femoral osteolysis progression (no change or osseous restoration) over 10 years if the osteolysis is less than 1000 mm2.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

References

  1. 1.
    Allain J, Roudot-Thoraval F, Delecrin J, Anract P, Migaud H, Goutallier D. Revision total hip arthroplasty performed after fracture of a ceramic femoral head: a multicenter survivorship study. J Bone Joint Surg Am. 2003;85:825–830.PubMedGoogle Scholar
  2. 2.
    Bohm P, Bischel O. Femoral revision with the Wagner SL revision stem: evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am. 2001;83:1023–1031.PubMedCrossRefGoogle Scholar
  3. 3.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.PubMedCrossRefGoogle Scholar
  4. 4.
    Chen XD, Waddell JP, Morton J, Schemitsch EH. Isolated acetabular revision after total hip arthroplasty: results at 5–9 years of follow-up. Int Orthop. 2005;29:277–280.PubMedCrossRefGoogle Scholar
  5. 5.
    DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.PubMedGoogle Scholar
  6. 6.
    Gozzard C, Blom A, Taylor A, Smith E, Learmonth I. A comparison of the reliability and validity of bone stock loss and classification systems used for revision hip surgery. J Arthroplasty. 2003;18:638–642.PubMedCrossRefGoogle Scholar
  7. 7.
    Hannouche D, Delambre J, Zadegan F, Sedel L, Nizard R. Is there a risk in placing a ceramic head on a previously implanted trunion? Clin Orthop Relat Res. 2010;468:3322–3327.PubMedCrossRefGoogle Scholar
  8. 8.
    Hernigou P, Bahramy T. Zirconia and alumina ceramics in comparison with metal heads: polyethylene wear after a minimum ten year follow-up. J Bone Joint Surg Br. 2003;85:504–509.PubMedCrossRefGoogle Scholar
  9. 9.
    Hernigou P, Intrator L, Bahrami T, Bensoussan A, Farcet JP. Interleukin 6 in the blood of patients with total hip arthroplasty without loosening. Clin Orthop Relat Res. 1999;366:147–154.PubMedCrossRefGoogle Scholar
  10. 10.
    Hernigou P, Zilber S, Filippini P, Poignard A. Ceramic-ceramic bearing decreases osteolysis: a 20-year study versus ceramic-polyethylene on the contralateral hip. Clin Orthop Relat Res. 2009;467:2274–2280.PubMedCrossRefGoogle Scholar
  11. 11.
    International Organization for Standardization. ISO 5832-9: Implants for Surgery—Metallic Materials—Part 9: Wrought High Nitrogen Stainless Steel. Geneva, Switzerland: International Organization for Standardization; 2007.Google Scholar
  12. 12.
    Lawless BM, Healy WL, Sharma S, Iorio R. Outcomes of isolated acetabular revision. Clin Orthop Relat Res. 2010;468:472–479.PubMedCrossRefGoogle Scholar
  13. 13.
    Lieberman JR, Moeckel BH, Evans BG, Salvati EA, Ranawat CS. Cement-within-cement revision hip arthroplasty. J Bone Joint Surg Br. 1993;75:869–871.PubMedGoogle Scholar
  14. 14.
    Manning DW, Ponce BA, Chiang PP, Harris WH, Burke DW. Isolated acetabular revision through the posterior approach: short-term results after revision of a recalled acetabular component. J Arthroplasty. 2005;20:723–729.PubMedCrossRefGoogle Scholar
  15. 15.
    Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6-year follow-up evaluation. J Arthroplasty. 1994;9:33–44.PubMedCrossRefGoogle Scholar
  16. 16.
    Pospischill M, Knahr K. Strategies for head and inlay exchange in revision hip arthroplasty. Int Orthop. 2011;35:261–265.PubMedCrossRefGoogle Scholar
  17. 17.
    Pulliam IT, Trousdale RT. Fracture of a ceramic femoral head after a revision operation: a case report. J Bone Joint Surg Am. 1997;79:118–121.PubMedGoogle Scholar
  18. 18.
    Saito M, Saito S, Ohzono K, Takaoka K, Ono K. Efficacy of alumina ceramic heads for cemented total hip arthroplasty. Clin Orthop Relat Res. 1992;283:171–177.PubMedGoogle Scholar
  19. 19.
    Schuller HM, Marti RK. Ten-year socket wear in 66 hip arthroplasties: ceramic versus metal heads. Acta Orthop Scand. 1990;61:240–243.PubMedCrossRefGoogle Scholar
  20. 20.
    Smith LK, Cramp F, Palmer S, Coghill N, Spencer RF. Use of morphometry to quantify osteolysis after total hip arthroplasty. Clin Orthop Relat Res. 2010;468:3077–3083.PubMedCrossRefGoogle Scholar
  21. 21.
    Sugano N, Nishii T, Nakata K, Masuhara K, Takaoka K. Polyethylene sockets and alumina ceramic heads in cemented total hip arthroplasty: a ten-year study. J Bone Joint Surg Br. 1995;77:548–556.PubMedGoogle Scholar
  22. 22.
    Wroblewski BM, Siney PD, Dowson D, Collins SN. Prospective clinical and joint simulator studies of a new total hip arthroplasty using alumina ceramic heads and cross-linked polyethylene cups. J Bone Joint Surg Br. 1996;78:280–285.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Philippe Hernigou
    • 1
  • Nicolas Dupuy
    • 1
  • Olivier Pidet
    • 1
  • Yashuhiro Homma
    • 2
  • Charles Henri Flouzat Lachaniette
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity Paris East (UPEC)CreteilFrance
  2. 2.Department of Orthopaedic SurgeryJuntendo UniversityTokyoJapan

Personalised recommendations