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Extremely high fracture rate of a modular acetabular component with a sandwich polyethylene ceramic insertion for THA: a preliminary report

  • Orthopaedic Surgery
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Abstract

Improvements of ceramic components and design changes have reduced failure rates over the past 30 years in total hip arthroplasty. We present a series of n = 11 cases with ceramic failure out of n = 113 implantations, from which n = 66 were ceramic-on-ceramic (n = 50 with ceramic insert with sandwich in polyethylene and n = 16 with directly fixed ceramic inlay) and n = 47 ceramic on polyethylene bearings, between 1999 and 2001 after introduction of a new implantation system to the market. The overall fracture rate of ceramic for the whole series (n = 113) was 9.7%. For the combination ceramic head with UHMW-PE (n = 47) the fracture rate was 2.1%. For the combination ceramic with ceramic (n = 66) the fracture rate was 15.2%. For the combination ceramic with ceramic sandwich in PE (n = 50) the failure rate was 18%. Only three patients experienced a trauma. Demography of patients (age, gender, body weight and BMI) was not statistically different between patients with failed ceramics and the rest of the patients making patient-specific risk factors unlikely to be an explanation for the failures. Retrospective X-ray analysis of the cup positioning did not show significant difference between failed and non-failed implants in terms of mean cup inclination and version making also operation-specific factors unlikely to be the only reason of this high failure rate. Therefore, manufacturer-specific factors such as design features may have contributed to this high failure rate. Further analysis of the whole series with biomechanical testing of the retrieved material needs to be performed.

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References

  1. Allain J, Goutallier D, Voisin MC, Lemouel S (1998) Failure of a stainless-steel femoral head of a revision total hip arthroplasty performed after a fracture of a ceramic femoral head. A case report. J Bone Joint Surg Am 80:1355–1360

    Article  PubMed  CAS  Google Scholar 

  2. Bader R, Scholz R, Steinhauser E, Busch R, Mittelmeier W (2004) Method for the evaluation of factors influencing the dislocation stability of total hip endoprotheses. Biomed Tech (Berl) 49:137–144

    CAS  Google Scholar 

  3. Bader R, Scholz R, Steinhauser E, Zimmermann S, Busch R, Mittelmeier W (2004) The influence of head and neck geometry on stability of total hip replacement: a mechanical test study. Acta Orthop Scand 75:415–421

    Article  PubMed  Google Scholar 

  4. Bader R, Steinhauser E, Gradinger R, Willmann G, Mittelmeier W (2002) Computer-based motion simulation of total hip prostheses with ceramic-on-ceramic wear couple. Analysis of implant design and orientation as influence parameters. Z Orthop Ihre Grenzgeb 140:310–316

    Article  PubMed  CAS  Google Scholar 

  5. Bader R, Willmann G (1999) Ceramic cups for hip endoprostheses. 6: Cup design, inclination and antetorsion angle modify range of motion and impingement. Biomed Tech (Berl) 44:212–219

    Article  CAS  Google Scholar 

  6. Boehler M, Plenk H, Jr, Salter M (2000) Alumina ceramic bearings for hip endoprostheses: the Austrian experiences. Clin Orthop 379:85–93

    Google Scholar 

  7. Boutin P (2000) Total hip arthroplasty using a ceramic prosthesis. Pierre Boutin (1924–1989). Clin Orthop Relat Res 379:3–11

    Google Scholar 

  8. Boutin P, Blanquaert D (1981) A study of the mechanical properties of alumina-on-alumina total hip prosthesis (author's transl). Rev Chir Orthop Reparatrice Appar Mot 67:279–287

    PubMed  CAS  Google Scholar 

  9. Boutin P, Christel P, Dorlot JM, Meunier A, de Roquancourt A, Blanquaert D, Herman S, Sedel L, Witvoet J (1988) The use of dense alumina-alumina ceramic combination in total hip replacement. J Biomed Mater Res 22:1203–1232

    Article  PubMed  CAS  Google Scholar 

  10. Burckhardt A, Berberat C (1993) How safe are ceramic heads as hip cndoprostheses? A series of three head fractures within 3 months. Arch Orthop Trauma Surg 112:215–219

    Article  PubMed  CAS  Google Scholar 

  11. Charnley J (1979) Low friction arthroplasty of the hip. Springer, Berlin, p 246

  12. Cini L, Sandrolini S, Paltrinieri M, Pizzoferrato A, Trentani C (1972) Bioceramic materials for replacement purposes. Preliminary note. Chir Organi Mov 60:423–430

    PubMed  CAS  Google Scholar 

  13. D’Antonio J, Capello W, Manley M, Bierbaum B (2002) New experience with alumina-on-alumina ceramic bearings for total hip arthroplasty. J Arthroplasty 17:390–397

    Article  PubMed  Google Scholar 

  14. D’Antonio J, Capello W, Manley M, Naughton M, Sutton K (2005) Alumina ceramic bearings for total hip arthroplasty: five-year results of a prospective randomized study. Clin Orthop Relat Res 436:164–171

    Article  PubMed  Google Scholar 

  15. Fritsch EW, Gleitz M (1996) Ceramic femoral head fractures in total hip arthroplasty. Clin Orthop 328:129–136

    Article  PubMed  Google Scholar 

  16. Garino JP (2000) Modem ceramic-on-ceramic total hip systems in the United States: early results. Clin Orthop 379:41–47

    Article  PubMed  Google Scholar 

  17. Griss P, Andrian-Werburg HF, Heimke G, Krempien B, Reipa S, Hartung HJ, Lauterbach HJ (1975) Results of experimental tests and clinical application possibilities of aluminum oxide ceramics in alloarthroplasty. Z Orthop Ihre Grenzgeb 113:756–759

    PubMed  CAS  Google Scholar 

  18. Hamadouche M, Boutin P, Daussange J, Bolander ME, Sedel L (2002) Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study. J Bone Joint Surg Am 84-A:69–77

    Google Scholar 

  19. Hernigou P, Bahrami T (2003) Zirconia and alumina ceramics in comparison with stainless-steel heads. Polyethylene wear after a minimum ten-year follow-up. J Bone Joint Surg Br 85:504–509

    Article  PubMed  CAS  Google Scholar 

  20. Higuchi F, Shiba N, Inoue A, Wakebe I (1995) Fracture of an alumina ceramic head in total hip arthroplasty. J Arthroplasty 10:851–854

    Article  PubMed  CAS  Google Scholar 

  21. Hoffinger SA, Keggi KJ, Zatorski LE (1991) Primary ceramic hip replacement: a prospective study of 119 hips. Orthopedics 14:523–531

    PubMed  CAS  Google Scholar 

  22. Huo MH, Martin RP, Zatorski LE, Keggi KJ (1996) Total hip replacements using the ceramic Mittelmeier prosthesis. Clin Orthop Relat Res 332:143–150

    Google Scholar 

  23. Krikler SJ (1998) Fracture of a ceramic femoral head after a revision operation. A case report (79-A:118–121, Jan 1997). J Bone Joint Surg Am 80:1085

    PubMed  CAS  Google Scholar 

  24. Maccauro G, Piconi C (2000) Ceramic femoral head fracture in total hip replacement. Int Orthop 24:239

    Article  PubMed  CAS  Google Scholar 

  25. McLean CR, Dabis H, Mok D (2002) Delayed fracture of the ceramic femoral head after trauma. J Arthroplasty 17:503–504

    Article  PubMed  CAS  Google Scholar 

  26. Merkert P (2003) Next generation ceramic bearings. In: Zippel H, Dietrich M (eds) Bioceramics in joint arthroplasty. Steinkopff Verlag Darmstadt, Darmstadt, pp 123–125

    Google Scholar 

  27. Mittelmeier H (1975) New development of wear-resistant ceramic and metal composite prostheses with ribbed support shafts for cement-free implantation. Hefte Unfallheilkd Nov(126):333–336

    Google Scholar 

  28. Nizard J, Sedel RS, Christel L, Meunier P, Soudry A, Witvoet M (1992) Ten-year survivorship of cemented ceramic-ceramic total hip prosthesis. Clin Orthop Relat Res 282:53–63

    PubMed  Google Scholar 

  29. O’Leary JF, Mallory TH, Kraus TJ, Lombardi AV, Jr, Lye CL (1988) Mittelmeier ceramic total hip arthroplasty. A retrospective study. J Arthroplasty 3:87–96

    Article  PubMed  Google Scholar 

  30. Piconi C, Labanti M, Magnani G, Caporale M, Maccauro G, Magliocchetti G (1999) Analysis of a failed alumina THR ball head. Biomaterials 20:1637–1646

    Article  PubMed  CAS  Google Scholar 

  31. Pignatti G, Stagni C, Fravisini M, Giunti A (2003) Ceramic-ceramic coupling. Total hip arthroplasty in young patients. Chir Organi Mov 88:369–375

    PubMed  CAS  Google Scholar 

  32. Pulliam IT, Trousdale RT (1997) Fracture of a ceramic femoral head after a revision operation. A case report. J Bone Joint Surg Am 79:118–121

    PubMed  CAS  Google Scholar 

  33. Salzer M, Zweymuller K, Locke H, Zeibig A, Stark N, Plenk H Jr, Punzet G (1976) Further experimental and clinical experience with aluminum oxide endoprostheses. J Biomed Mater Res 10:847–856

    Article  PubMed  CAS  Google Scholar 

  34. Sedel L (2000) Evolution of alumina-on-alumina implants: a review. Clin Orthop Relat Res 379:48–54

    Article  PubMed  Google Scholar 

  35. Suzuki K, Matsubara M, Morita S, Muneta T, Shinomiya K (2003) Fracture of a ceramic acetabular insert after ceramic-on-ceramic THA—a case report. Acta Orthop Scand 74:101–103

    Article  PubMed  Google Scholar 

  36. Toni A, Terzi S, Sudanese A, Zappoli FA, Giunti A (1996) Fracture of the ceramic epiphysis in hip arthroplasty. Chir Organi Mov 81:11–19

    PubMed  CAS  Google Scholar 

  37. Willmann G (2000) Ceramic femoral head retrieval data. Clin Orthop Relat Res 379:22–28

    Article  PubMed  Google Scholar 

  38. Yoo JJ, Kim YM, Yoon KS, Koo KH, Song WS, Kim HJ (2005) Alumina-on-alumina total hip arthroplasty. A five-year minimum follow-up study. J Bone Joint Surg Am 87:530–535

    Article  PubMed  Google Scholar 

  39. Yoon TR, Rowe SM, Jung ST, Seon KJ, Maloney WJ (1998) Osteolysis in association with a total hip arthroplasty with ceramic bearing surfaces. J Bone Joint Surg Am 80:1459–1468

    Google Scholar 

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Authors and Affiliations

  1. Orthopädische Klinik und Poliklinik, Universität Rostock, Doberaner Strasse 142, 18057, Rostock, Germany

    Jörn Kircher, Rainer Bader, Bettina Schroeder & Wolfram Mittelmeier

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  1. Jörn Kircher
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  2. Rainer Bader
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  3. Bettina Schroeder
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  4. Wolfram Mittelmeier
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Correspondence to Jörn Kircher.

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Kircher, J., Bader, R., Schroeder, B. et al. Extremely high fracture rate of a modular acetabular component with a sandwich polyethylene ceramic insertion for THA: a preliminary report. Arch Orthop Trauma Surg 129, 1145–1150 (2009). https://doi.org/10.1007/s00402-008-0662-2

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