MID-AND LONG-TERM EFFECTIVENESS OF THIRD-GENERATION CERAMICON-CERAMIC TOTAL HIP ARTHROPLASTY IN YOUNGER PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGuoyang ,  SUNJunying , ZHAGuochun , ZHAOXijiang , WANGTao , YOUZhenjun , ZHAOKangquan , XUNing

Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P. R. China;

Corresponding?author：

SUNJunying, Email: junying_s@126.com

Keywords：

Total hip arthroplasty; Third-generation ceramic-on-ceramic prosthesis; Osteolysis; Loosening; Younger patient

DOI：

10.7507/1002-1892.20150229

Video：

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Objective To analyze the mid-and long-term effectiveness of the 3rd-generation ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in the younger patients. Methods A retrospective analysis was made on the clinical data of 68 younger patients (73 hips) who accepted the 3rd-generation CoC THA between March 2001 and May 2009. Of 68 cases, 39 was male and 29 was female with the average age of 38.6 years (range, 18-50 years); there were 15 cases (15 hips) of osteonecrosis of the femoral head, 9 cases (9 hips) congenital dysplasia of the hip, 5 cases (8 hips) of ankylosing spondylitis, 10 cases (10 hips) of osteoarthritis of the hip joint, 12 cases (12 hips) of traumatic hip arthritis, 12 cases (12 hips) of femoral neck fracture, 4 cases (6 hips) of rheumatoid hip arthritis, and 1 case (1 hip) of tumor of the femoral neck. The Harris score and University of California Los Angeles (UCLA) score were used to evaluate the hip joint function and activity level respectively. The visual analogue scale (VAS) was used to assess postoperative thigh pain. Radiological signs of osteolysis, loosening, and alumina ceramic related complications were evaluated continuously. And the KaplanMeier survival analysis was used to assess the prosthesis survival. Results The average duration of follow-up was 9.7 years (range, 6-14 years). Sandwich ceramic liners fracture was observed in 3 cases (3 hips), and revision was performed; 1 case had "squeaking" hip because of physical activity. At last follow-up, Harris score and UCLA score were significantly improved when compared with preoperative scores (P<0.05). Bony healing was obtained in all patients, without osteolysis, loosening, and thigh pain. The VAS score was 0. The 5-year and 10-year cumulative survival rates for ceramic fracture revision were 98.6% and 95.9%, and the 5-year and 10-year cumulative survival rates for osteolysis and loosening revision both were 100%. Conclusion The 3rd-generation CoC prosthesis offer an excellent option for younger patients in THA and the mid-and long-term effectiveness are satisfactory.

Citation： WANGuoyang, SUNJunying, ZHAGuochun, ZHAOXijiang, WANGTao, YOUZhenjun, ZHAOKangquan, XUNing. MID-AND LONG-TERM EFFECTIVENESS OF THIRD-GENERATION CERAMICON-CERAMIC TOTAL HIP ARTHROPLASTY IN YOUNGER PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1057-1061. doi: 10.7507/1002-1892.20150229 Copy

1.	魏召勸, 孫俊英, 查國春, 等. 采用高交聯聚乙烯與傳統聚乙烯髖臼內襯行人工全髖關節置換的比較研究. 中國修復重建外科雜志, 2013, 27(12):1414-1418.
2.	M?kel? KT, Eskelinen A, Pulkkinen P, et al. Results of 3,668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years. Acta Orthop, 2011, 82(5):521-529.
3.	Furnes O, Paxton E, Cafri G, et al. Distributed analysis of hip implants using six national and regional registries:comparing metalon-metal with metal-on-highly cross-linked polyethylene bearings in cementless total hip arthroplasty in young patients. J Bone Joint Surg (Am), 2014, 96 Suppl 1:25-33.
4.	Schroder DT, Kelly NH, Wright TM, et al. Retrieved highly crosslinked UHMWPE acetabular liners have similar wear damage as conventional UHMWPE. Clin Orthop Relat Res, 2011, 469(2): 387-394.
5.	D'Antonio JA, Capello WN, Naughton M. Ceramic bearings for total hip arthroplasty have high survivorship at 10 years. Clin Orthop Relat Res, 2014, 472(2):611-616.
6.	Zahiri CA, Schmalzried TP, Szuszczewicz ES, et al. Assessing activity in joint replacement patients. J Arthroplasty, 1998, 13(8):890-895.
7.	Mulliken BI, Bourne RB, Rorabeck CH, et al. A tapered titaniam femoral stem inserted without cement in a total hip arthroplasty: radiographic evaluation and stability. J Bone Joint Surg (Am), 1996, 78(8):1214-1225.
8.	Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2):228-232.
9.	Woo RY, Morrey BF. Dislocations after totalhip arthroplasty. J Bone Joint Surg (Am), 1982, 64(9):1295-1306.
10.	Kawamura H, Dunbar MJ, Murray P, et al. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9):1333-1338.
11.	Engh CA Jr, Culpepper WJ, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg (Am), 1997, 79(2):177-184.
12.	DeLee JG, Charnley J. Radiological demarcation ofcemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121):20-32.
13.	Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components:a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141):17-27.
14.	D'Antonio JA, Capello WN, Manley MT. Remodeling of bone around hydroxyapatite-coated femoral stems. J Bone Joint Surg (Am), 1996, 78(8):1226-1234.
15.	Haidukewych GJ, Petrie J. Bearing surface considerations for total hip arthroplasty in young patients. Orthop Clin North Am, 2012, 43(3):395-402.
16.	Saikko V, Pfaff HG. Low wear and friction in alumina/alumina total hip joints:a hip simulator study. Acta Orthop Scand, 1998, 69(5):443-448.
17.	Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. Int Orthop, 2010, 34(8):1123-1127.
18.	Vendittoli PA, Rivière C, Lavigne M, et al. Alumina on alumina versus metal on conventional polyethylene:a randomized clinical trial with 9 to 15 years follow-up. Acta Orthop Belg, 2013, 79(2):181-190.
19.	Petit A, Catelas I, Antoniou J, et al. Differential apoptotic response of J774 macrophages to alumina and ultra-high-molecular-weight polyethylene particles. J Orthop Res, 2002, 20(1):9-15.
20.	Koo KH, Ha YC, Kim SY, et al. Revision of ceramic head fracture after third generation ceramic-on-ceramic total hip arthroplasty. J Arthroplasty, 2014, 29(1):214-218.
21.	Shin JJ, Shin JS, Kim JH, et al. Experience with sandwich liner and its high rate of failure. Eur J Orthop Surg Traumatol, 2015, 25(2):233-242.
22.	Ha YC, Kim SY, Kim HJ, et al. Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. J Trauma, 2007, 63(5):1054-1060.
23.	Yeung E, Bott PT, Chana R, et al. Mid-term results of thirdgeneration alumina-on-alumina ceramic bearings in cementless total hip arthroplasty:a ten-year minimum follow-up. J Bone Joint Surg (Am), 2012, 94(2):138-144.
24.	Stanat SJ, Capozzi JD. Squeaking in third-and fourth-generation ceramic-on-ceramic total hip arthroplasty:meta-analysis and systematic review. J Arthroplasty, 2012, 27(3):445-453.
25.	Keurentjes JC, Kuipers RM, Wever DJ, et al. High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res, 2008, 466(6):1438-1443.
26.	Tozun IR, Ozden VE, Dikmen G, et al. Mid-term result of ceramic bearings in total hip arthroplasty. Int Orthop, 2014, 38(10):2027-2031.
27.	Capello WN, D'Antonio JA, Feinberg JR, et al. Ceramic-on-ceramic total hip arthroplasty:update. J Arthroplasty, 2008, 23(7 Suppl):39-43.

1. 魏召勸, 孫俊英, 查國春, 等. 采用高交聯聚乙烯與傳統聚乙烯髖臼內襯行人工全髖關節置換的比較研究. 中國修復重建外科雜志, 2013, 27(12):1414-1418.
2. M?kel? KT, Eskelinen A, Pulkkinen P, et al. Results of 3,668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years. Acta Orthop, 2011, 82(5):521-529.
3. Furnes O, Paxton E, Cafri G, et al. Distributed analysis of hip implants using six national and regional registries:comparing metalon-metal with metal-on-highly cross-linked polyethylene bearings in cementless total hip arthroplasty in young patients. J Bone Joint Surg (Am), 2014, 96 Suppl 1:25-33.
4. Schroder DT, Kelly NH, Wright TM, et al. Retrieved highly crosslinked UHMWPE acetabular liners have similar wear damage as conventional UHMWPE. Clin Orthop Relat Res, 2011, 469(2): 387-394.
5. D'Antonio JA, Capello WN, Naughton M. Ceramic bearings for total hip arthroplasty have high survivorship at 10 years. Clin Orthop Relat Res, 2014, 472(2):611-616.
6. Zahiri CA, Schmalzried TP, Szuszczewicz ES, et al. Assessing activity in joint replacement patients. J Arthroplasty, 1998, 13(8):890-895.
7. Mulliken BI, Bourne RB, Rorabeck CH, et al. A tapered titaniam femoral stem inserted without cement in a total hip arthroplasty: radiographic evaluation and stability. J Bone Joint Surg (Am), 1996, 78(8):1214-1225.
8. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2):228-232.
9. Woo RY, Morrey BF. Dislocations after totalhip arthroplasty. J Bone Joint Surg (Am), 1982, 64(9):1295-1306.
10. Kawamura H, Dunbar MJ, Murray P, et al. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9):1333-1338.
11. Engh CA Jr, Culpepper WJ, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg (Am), 1997, 79(2):177-184.
12. DeLee JG, Charnley J. Radiological demarcation ofcemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121):20-32.
13. Gruen TA, McNeice GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components:a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141):17-27.
14. D'Antonio JA, Capello WN, Manley MT. Remodeling of bone around hydroxyapatite-coated femoral stems. J Bone Joint Surg (Am), 1996, 78(8):1226-1234.
15. Haidukewych GJ, Petrie J. Bearing surface considerations for total hip arthroplasty in young patients. Orthop Clin North Am, 2012, 43(3):395-402.
16. Saikko V, Pfaff HG. Low wear and friction in alumina/alumina total hip joints:a hip simulator study. Acta Orthop Scand, 1998, 69(5):443-448.
17. Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. Int Orthop, 2010, 34(8):1123-1127.
18. Vendittoli PA, Rivière C, Lavigne M, et al. Alumina on alumina versus metal on conventional polyethylene:a randomized clinical trial with 9 to 15 years follow-up. Acta Orthop Belg, 2013, 79(2):181-190.
19. Petit A, Catelas I, Antoniou J, et al. Differential apoptotic response of J774 macrophages to alumina and ultra-high-molecular-weight polyethylene particles. J Orthop Res, 2002, 20(1):9-15.
20. Koo KH, Ha YC, Kim SY, et al. Revision of ceramic head fracture after third generation ceramic-on-ceramic total hip arthroplasty. J Arthroplasty, 2014, 29(1):214-218.
21. Shin JJ, Shin JS, Kim JH, et al. Experience with sandwich liner and its high rate of failure. Eur J Orthop Surg Traumatol, 2015, 25(2):233-242.
22. Ha YC, Kim SY, Kim HJ, et al. Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. J Trauma, 2007, 63(5):1054-1060.
23. Yeung E, Bott PT, Chana R, et al. Mid-term results of thirdgeneration alumina-on-alumina ceramic bearings in cementless total hip arthroplasty:a ten-year minimum follow-up. J Bone Joint Surg (Am), 2012, 94(2):138-144.
24. Stanat SJ, Capozzi JD. Squeaking in third-and fourth-generation ceramic-on-ceramic total hip arthroplasty:meta-analysis and systematic review. J Arthroplasty, 2012, 27(3):445-453.
25. Keurentjes JC, Kuipers RM, Wever DJ, et al. High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res, 2008, 466(6):1438-1443.
26. Tozun IR, Ozden VE, Dikmen G, et al. Mid-term result of ceramic bearings in total hip arthroplasty. Int Orthop, 2014, 38(10):2027-2031.
27. Capello WN, D'Antonio JA, Feinberg JR, et al. Ceramic-on-ceramic total hip arthroplasty:update. J Arthroplasty, 2008, 23(7 Suppl):39-43.

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Chinese Journal of Reparative and Reconstructive Surgery

MID-AND LONG-TERM EFFECTIVENESS OF THIRD-GENERATION CERAMICON-CERAMIC TOTAL HIP ARTHROPLASTY IN YOUNGER PATIENTS

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