Total Hip Arthroplasty: Wear Behaviour of Different Articulations

180 Pages·2012·5.63 MB·English

by  John Fisher CBE

Total Hip Arthroplasty

Karl Knahr
Editor
Total Hip Arthroplasty
Wear Behaviour of Diff erent Articulations
Editor
Prof. Dr. Karl Knahr
Orthopaedic Hospital Vienna-Speising
Vienna
Austria
ISBN 978-3-642-27360-5 e-ISBN 978-3-642-27361-2
DOI 10.1007/978-3-642-27361-2
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2012934742
© EFORT 2012
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Preface
There are four important criteria essential for a successful implant to achieve long-term
stability and function: material, design, fi xation of the prosthesis and wear of the articula-
tion. Stability is achieved by fi xation with bone cement or cementless press-fi t using dif-
ferent designs of stems and cups. There are hundreds of implants on the market, all of them
offering excellent results when used.
In contrast to the numerous implant designs, there are only three materials available to
support the demands of long-term function: polyethylene, metal and ceramics. Wear of
these articulating materials is one of the most important factors for successful long-term
results in total hip arthroplasty.
In the early days of total hip arthroplasty, a metal head articulating with a conventional
polyethylene cup was the gold standard. Unfortunately in many cases wear debris after long-
term function resulted in osteolysis around the implant with subsequent loosening.
Consequently, new materials and new options of combinations between cup and stem were
introduced. Hard-on-hard bearings (metal-on-metal, ceramic-on-ceramic) became more and
more popular, but their popularity was compromised by allergic reaction of metal, pseudotu-
mours, fracture or squeaking of the articulating material. Consequently implant companies
focused on development activities to overcome the shortcomings of their products.
Conventional polyethylene was improved by high cross-linking techniques and furthermore
by adding vitamin K. Pure aluminium oxide ceramic was improved by introducing ceramic
composite implants.
The Tribology Day at the 12th EFORT Congress in Copenhagen focused on all these
new products and their effectiveness in clinical use. Polyethylene topics cover the analysis
of infl uence of vitamin E-blended cross-linked polyethylene in in vitro wear testing as well
as in long-term clinical use. Metal-on-metal articulations are recently faced with loss of
reputation due to allergic reactions and pseudotumours, especially in large-diameter head
implants. Retrieval analyses and clinical survival papers address these issues. Fracture and
squeaking are the main concerns with ceramic-on-ceramic articulations. Their frequency
and clinical relevance are discussed and long-term results presented.
The authors of this book contributions hope that their chapters will meet your expecta-
tions and give a better insight to a still on-going improvement of wear reduction in total hip
arthroplasty.
K. Knahr
v

vii
Contents
Part I Introduction
1 Tribology of Hip Prostheses, Wear Performance and Reliability,
Effect of Materials and Head Size ..................................................................... 3
John Fisher
2 How to Treat Failures Related to Articulation ................................................. 9
Luigi Zagra, Luca Bianchi, and Roberto Giacometti Ceroni
Part II Polyethylene Articulations
3 Oxidation Prevention with Vitamin E in a HXLPE Isoelastic
Monoblock Pressfi t Cup: Preliminary Results ................................................. 21
Martin Beck, Daniel Delfosse, Reto Lerf, Roland Becker, Gary French,
Lutz Hollmann, Karl Knahr, Helmy Naeder, Eric Meijer,
Philipp Rehbein, Joseph Baines, Vincent Steenmeijer, and Arthur de Gast
4 In Vitro Wear Testing of Conventional Versus Sequentially
Cross-Linked Polyethylene Liners in Combination with
Different Sizes of Ceramic Femoral Heads ....................................................... 33
Carmen Zietz, Andreas Fritsche, Lars Middelborg, Wolfram Mittelmeier,
and Rainer Bader
5 Characterisation of Vitamin E–Blended UHMWPE for Higher
In Vivo Performance in Orthopaedic Arthroplasty ......................................... 41
Luigi Costa, Marco Regis, Pierangiola Bracco, Luca Giorgini,
and Simonetta Fusi
6 Long-Term Reduction of Wear and Osteolysis with Cross-Linked PE?
13-Year Follow-up of a Prospectively Randomized Comparison with
Conventional PE .................................................................................................. 59
Bernd Grimm, Alphons Tonino, and Ide Christiaan Heyligers
vii
viii Contents
Part III Metal Articulations
7 Metal-on-Metal Bearings in Hip Surgery: The London Implant
Retrieval Centre Experience ............................................................................ 73
John Skinner, Alister Hart, and Ashley Matthies
8 Total Hip Arthroplasty with a Large-Diameter Metal-on-Metal
Cup (Durom) and a Standard Stem: Short-Term Results ............................ 91
Panayiotis Christofi lopoulos, Anne Lübbeke, Charles Berton,
Alexandre Lädermann, Martin Berli, Constantinos Roussos,
Alexis Bonvin, Robin Peter, and Pierre Hoffmeyer
9 Polyethylene Wear in Metal-Backed Cups:
A Retrospective Analysis of 200 Uncemented Prostheses ................................ 99
WWalter van der Weegen, Shennah Austen, Thea Sijbesma, and Henk J. Hoekstra
10 Immunological Adverse Reaction Associated with Low Carbide
Content Metal-on-Metal Bearings in a Contemporary Cementless
Total Hip Arthroplasty ..................................................................................... 113
Panagiotis Korovessis, Thomas Repantis, Panagiotis Aroukatos,
and Maria Repanti
Part IV Ceramic Articulations
11 Fracture and Squeaking in Ceramic-on-Ceramic Bearings:
Is It Really a Concern? ..................................................................................... 127
Alexandra Pokorny and Karl Knahr
12 Long-Term Stability of Ceramic Composite in Total Hip Arthroplasty ...... 145
Bernard Masson and Meinhard Kuntz
13 Ceramic-on-Ceramic Bearings in Hip Arthroplasty:
A Clinical Review .............................................................................................. 155
James M. Buchanan
Part V Miscellaneous
14 Study of a Titanium Dual-Mobility Socket with a Mean Follow-up
of 18 Years.......................................................................................................... 161
Remy Philippot, B. Boyer, and F. Farizon
15 ECiMa™ for Low Wear, Optimal Mechanical Properties and Oxidation
Resistance of Hip Bearings............................................................................... 169
Alison Traynor, David Simpson, and Simon Collins
Index ........................................................................................................................... 183
Part I
Introduction
1
Tribology of Hip Prostheses,
Wear Performance and Reliability,
Effect of Materials and Head Size
John Fisher
1.1
Introduction
Wear and adverse reactions to wear particles remain a concern, particularly with young
and active patients with long life expectancies [1 2, 13 ] . There is considerable interest in
the clinical use of improved bearing materials such as cross-linked polyethylene, metal on
metal, ceramic on ceramic and ceramic on metal [6 ] . In addition to reducing wear, there is
also clinical interest in using larger head sizes to improve stability and range of motion [6 ] .
However, in polyethylene bearings, a larger head size can lead to increased wear [8 , 16 ] .
Most previous research work has studied the wear performance of bearings under a stan-
dard set of walking conditions with components correctly positioned. Indeed, with
improvements in bearing technology, the wear under standard walking conditions has
reduced to low levels, and this has encouraged the use of diameter larger heads. However,
in addition, it has become increasingly important to consider the wear under a much wider
range of conditions and variations which may be introduced by different activities, by
individual patients or the surgery (such as component position). Under a broader and more
realistic set of conditions, the wear in some bearings may increase dramatically, and this
may increase failure and reduce reliability [2 4 ] .
In this short review, the wear performance of different bearing materials and different
head sizes is considered under standard walking conditions. In addition, the tribological
performance under conditions which may cause extremely high wear rates and reduce
reliability and increase failure are also considered.
J. Fisher , CBE, FREng, FIMECHE, FIPEM, CEng, CSci
Institute of Medical and Biological Engineering, University of Leeds ,
Leeds , LS2 9JT , UK
e-mail: j.fi [email protected]
K. Knahr (ed.), Total Hip Arthroplasty, 3
DOI 10.1007/978-3-642-27361-2_1, © 2012 EFORT