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Douglas E. Padgett - One of the best experts on this subject based on the ideXlab platform.
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Ceramic Liner fractures presenting as squeaking after primary total hip arthroplasty
Journal of Bone and Joint Surgery American Volume, 2014Co-Authors: Matthew P Abdel, Thomas J Heyse, Marcella E Elpers, David J Mayman, Paul M Pellicci, Timothy M Wright, Douglas E. PadgettAbstract:Background Squeaking after Ceramic-on-Ceramic total hip arthroplasty is a relatively uncommon phenomenon. It usually does not require treatment in the absence of pain, mechanical symptoms, and/or relentless squeaking. The purpose of this investigation was to report on four patients who presented with hip pain and squeaking due to fractured Ceramic Liners after Ceramic-on-Ceramic total hip arthroplasty. Methods Four patients with painful squeaking after Ceramic-on-Ceramic total hip arthroplasty were seen at our institution. One patient had a revision for suspected loosening and excessive anteversion of the cup noted on radiographs and magnetic resonance imaging (MRI). The remaining three patients had a revision for audible squeaking with progressive pain. Results Intraoperatively, the Ceramic Liners of all four patients were fractured. Conclusions Squeaking after Ceramic-on-Ceramic total hip arthroplasty rarely is a functional issue. However, painful squeaking without notable trauma may indicate fracture of the Ceramic Liner. Painful squeaking is difficult to evaluate by conventional imaging. When painful squeaking occurs, exploration via surgical revision is recommended in selected patients, as Ceramic Liner fractures may go unnoticed on radiographs and/or MRI and thus their actual prevalence may be higher than estimated.
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Incidence of Ceramic Liner malseating in trident® acetabular shell
Clinical Orthopaedics and Related Research, 2009Co-Authors: Anna N Miller, Bryan J Nestor, Edwin P. Su, Mathias P G Bostrom, Douglas E. PadgettAbstract:The low wear rates associated with Ceramic hip articulations have made them a popular bearing for younger patients. Although few complications have been observed, one report revealed several instances of incomplete seating of the Ceramic Liner in the metallic shell. We performed a cohort study of consecutive THAs using a Ceramic-Ceramic bearing. Radiographic analysis showed 50 (7.2%) of the group of 694 hips had evidence of incomplete seating of the Liner in the metallic shell. Although we observed no adverse effects at 6 to 12 weeks, we encourage surgeons to carefully assess Liner placement in the metal shell at the time of surgery to avoid this unintended consequence and to assess placement at the time of followup so patients can be properly followed when incomplete seating is identified. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Kyunghoi Koo - One of the best experts on this subject based on the ideXlab platform.
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preventing Ceramic Liner fracture after delta Ceramic on Ceramic total hip arthroplasty
Archives of Orthopaedic and Trauma Surgery, 2021Co-Authors: Youngkyun Lee, Kyunghoi Koo, Jaeyoung Lim, Taeyoung Kim, Woonhwa JungAbstract:The results of total hip arthroplasty (THA) with use of Delta Ceramic articulation were successful at medium term follow-up. The use of this newest Ceramic has markedly reduced the incidence of Ceramic head fractures, but not the incidence of Ceramic Liner fractures. We tested a hypothesis that the Ceramic fractures are prevented by use of a metal shell with 18° inner taper angle and a stem design with a reduced neck geometry. We conducted a prospective multicenter study of cementless THA with use of 32/36-mm Delta Ceramic bearing, Exceed ABT metal shell and Taperloc stem. We evaluated Ceramic fracture, noise, clinical results, radiological changes and survival rate at a minimum of 5-year follow-up. From April 2010 to February 2012, 246 patients (274 THAs) were enrolled. Among them, 224 patients (130 men and 94 women, 250 hips) were followed-up for 5–8 years (mean 6.0 years). Ceramic malseating or fracture did not occur in any patient. Eight patients (8 hips, 3.2%) reported noise. Mean Harris hip score was 84 points at the latest follow-up. All acetabular and femoral components had bone-ingrown stability. Two hips were revised due to recurrent dislocation and periprosthetic fracture. The survival rate was 99.6% at 8 years postoperatively. Ceramic fractures can be prevented by a use of (1) 32/36-mm Delta Ceramic bearing, (2) metal shell with 18° taper angle, and (2) stem with a reduced neck geometry. However, noise remains a concern of the Delta Ceramic bearing. Therapeutic level II.
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midterm results of large diameter biolox forte Ceramic head on delta Ceramic Liner articulation in total hip arthroplasty
Journal of Arthroplasty, 2014Co-Authors: Bunjung Kang, Sunchul Hwang, Youngkyun Lee, Kyunghoi KooAbstract:Seventy-nine patients (94 hips), who underwent cementless alumina-on-alumina total hip arthroplasty (THA) with the use of a 36-mm delta Ceramic Liner-on-alumina Ceramic femoral head, were followed for an average of 6.5years (range, 5-7.7years). All acetabular and femoral components were bone-ingrown and neither pelvic nor femoral osteolysis was identified until the latest follow-up. The survivorship with revision surgery as an endpoint was 97.9% (95% confidence interval=100%-95%). Ceramic related complications such as fracture and squeaking did not occur in any patient. The mid-term results of cementless THA with this type of Ceramic articulation are encouraging.
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metal neck and Liner impingement in Ceramic bearing total hip arthroplasty
Journal of Orthopaedic Research, 2011Co-Authors: Youngkyun Lee, Kyunghoi Koo, Jeong Joon Yoo, Kang Sup Yoon, Hee Joong KimAbstract:Although impingement between the neck of the metallic stem and the Ceramic Liner has been suspected to be the cause of Ceramic Liner failure in Ceramic-on-Ceramic total hip arthroplasty (THA), no report has directly demonstrated microscopic damage on Ceramic Liner. We performed 18 reoperations on 18 patients who had undergone third generation Ceramic-on-Ceramic THA. Considering impingement, 16 patients, who were reoperated more than 1 year after previous Ceramic bearing THA, were evaluated. Retrieved alumina Liners, showing evidence of impingement, were examined by means of visual inspection and scanning electron microscopy (SEM). Four of the 16 hips showed neck notching and black stained Liners, evidence of metallic neck to Ceramic impingement. Impinged alumina bearings had been implanted for an average of 62.5 months (range: 35–99 months) before reoperation. SEM of the black stained area demonstrated disruptive wear and loss of surface integrity. Furthermore, one Liner had multiple microcracks, and its cross-sectional SEM analysis revealed one microcrack propagating into the deep portion of the Ceramic Liner. Our observations suggest that metal neck-to-Ceramic impingement in Ceramic-on-Ceramic THA can cause microcrack formation in Ceramic Liner. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:218–222, 2011
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Ceramic Liner fracture after cementless alumina on alumina total hip arthroplasty
Clinical Orthopaedics and Related Research, 2006Co-Authors: Shin Yoon Kim, Hee Joong Kim, Jeong Joon Yoo, Kyunghoi KooAbstract:Advances in technology have reduced the risk of fracture of Ceramic total hip arthroplasty implants, but concerns remain about fracture of both components. We retrospectively reviewed 133 patients (157 hips) who had cementless alumina-on-alumina total hip arthroplasties with a sandwich-type acetabular component. Six patients (seven hips) died and five patients (six hips) were interviewed by telephone (95% followup). The 122 patients (144 hips) examined had a minimum followup of 36 months (average, 45 months; range, 36-68 months). All acetabular cups and femoral stems were radiographically stable at the last followup. Five hips in five patients (3.5%) were revised because of Ceramic Liner fractures. Ceramic Liner fractures occurred at a mean of 35 months (range, 24-48 months) postoperatively. Acetabular cups in the fracture group (n = 5) were more anteverted than those in the nonfracture group (n = 139). In three patients the fracture apparently occurred during squatting, resulting in hyperflexion and wide hip abduction. Early Ceramic Liner fracture was associated with impingement associated with excessive anteversion of the acetabular cup in Korean patients who habitually squat.
Kwonyong Lee - One of the best experts on this subject based on the ideXlab platform.
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applicability evaluation of direct metal tooling based additive manufacturing for reducing Ceramic Liner fracture in total hip arthroplasty
Surface & Coatings Technology, 2018Co-Authors: Taejin Shin, Yong Sik Kim, Jungsung Kim, Kwonyong Lee, Doohoon Sun, Young Wook Lim, Sungjae Lee, Dohyung LimAbstract:Abstract Recently, the combination of a press-fit acetabular cup and Ceramic articulation has been widely used for implanting cementless acetabular components and has been shown to provide good initial stability. However, this combination may lead to the failure of Ceramic Liners by their non-concentric seating due to acetabular cup deformation. To reduce the risk of this, we applied direct metal tooling (DMT)-based additive manufacturing (AM) with the hypothesis that DMT-based AM would minimize the deformation of the acetabular cup by increasing its strength, which would ultimately prevent the Ceramic Liner from fracturing. To confirm this, we performed post-fatigue tests simulating a press-fit situation for the acetabular cups subjected to DMT-based AM and compared them with the cups treated with titanium plasma spray (TPS). The post-fatigue tests were then performed under a maximum load of 14 kN for 20 × 10 7 cycles. The roundness and inner diameter of the cups and Liners were measured in all testing phases. The results revealed no differences between the acetabular cups subjected to DMT-based AM and TPS. However, when comparing only the mean values directly, the results for the acetabular cup subjected to DMT-based AM indicated that it might have increased the strength of the acetabular cup, compared with those treated with TPS, thereby minimizing the possibility of fracture of the Ceramic Liner. In conclusion, DMT-based AM was shown to be at least equivalent to TPS, or could possibly supersede it. Additionally, via DMT-based AM, it is possible to control the porous structure freely, so this approach allows a greater range of applications and potential for further improvement than TPS.
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Delayed fracture of a Ceramic insert with modern Ceramic total hip replacement.
Journal of Arthroplasty, 2006Co-Authors: Byung-woo Min, Kwang Soon Song, Chul-hyung Kang, Ki-cheol Bae, Ye-yeon Won, Kwonyong LeeAbstract:We report a case of Ceramic Liner fracture in a 34-year-old man that occurred 1 year 9 months after total hip arthroplasty with a BiCONTACT (Aesculap, Tuttlingen, Germany) Ceramic-on-Ceramic prosthesis. The Ceramic Liner was found within the metal shell in 4 large pieces and multiple small fragments in the peripheral portions. Its condition indicated that the possible mechanism of late Ceramic Liner chip fracture was repeated episodes of impingement between the prosthetic neck and the edge of the Ceramic Liner. Squatting, kneeling, and sitting cross-legged caused impingement. These positions are more common in Asian populations than in Western populations. After the joint was thoroughly irrigated, a new modular Ceramic Liner and a 28-mm Ceramic head were implanted.
Taisuke Seki - One of the best experts on this subject based on the ideXlab platform.
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what factors predict Ceramic Liner malseating after Ceramic on Ceramic total hip arthroplasty
Orthopaedics & Traumatology-surgery & Research, 2019Co-Authors: Yoshitoshi Higuchi, Taisuke Seki, Yasuhiko Takegami, Yusuke Osawa, Taiki Kusano, Naoki IshiguroAbstract:Abstract Background There is a lack of evidence about the risk factors associated with the malseating of the acetabular Liner after Ceramic-on-Ceramic (CoC) total hip arthroplasty (THA). Therefore, we performed a complementary retrospective case-control study to determine the factors predicting the malseating of the acetabular Liner after CoC THA and to evaluate the relationship between malseating and (1) osteoarthritis, (2) particularly in terms of the new radiographic parameter “bone sclerotic length” of the acetabular bone. Hypothesis Osteoarthritis, particularly bone sclerotic length, was an independent risk factor for malseating of Ceramic Liners. Patients and methods In total, 219 CoC THAs (174 women and 45 men) were evaluated to determine the risk factors influencing the malseating of the acetabular Ceramic Liner. An average patient age at the time of surgery was 55.9 ± 9.5 years (range, 23 to 75 years). Data on patient background and preoperative radiographs, such as Tonnis grades; Crowe classification; and indices of acetabular osteoarthritis change; including bone cyst, osteophyte and bone sclerosis, were assessed. The bone sclerotic length in patients with osteoarthritis was measured as the slant distance between the bilateral edges of the sclerosis lesion of the acetabulum on the anteroposterior view. Results Preoperative less hip flexion (hazard ratio [HR]: 0.98; 95% CI: 0.97–0.99), osteoarthritis (HR: 3.15; 95% CI: 1.02–9.70) and the bone sclerotic length (HR: 1.83; 95% CI: 1.35–2.48) were independent risk factors determining the malseating of Ceramic Liners. Receiver operating characteristic curve analysis showed that a bone sclerotic length of 24.6 mm was defined as the cut-off point for the malseating of the Ceramic Liner. Discussion Age, preoperative less flextion, osteoarthritis, and the bone sclerotic were independent risk factors determining malseating of Ceramic Liners. The acetabular shell can also deform upon insertion of the cup with sclerotic bone of the acetabulum and prevent correct seating of Liners. Therefore, these factors must be taken into consideration when seating the Ceramic Liner. Level of evidence Case control study III, case control retrospective design.
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incidence of Ceramic Liner malseating after Ceramic on Ceramic total hip arthroplasty associated with osteolysis a 5 to 15 year follow up study
Journal of Arthroplasty, 2017Co-Authors: Yoshitoshi Higuchi, Taisuke Seki, Yukiharu Hasegawa, Daigo Komatsu, Naoki IshiguroAbstract:Abstract Background The aim of our study was to evaluate the clinical and radiographic outcomes of malseating of the acetabular Liner in Ceramic-on-Ceramic total hip arthroplasty (THA). Methods Outcomes for 160 Ceramic-on-Ceramic THAs, contributed by 116 women and 39 men, were evaluated. Clinical and radiographic measurements were obtained over a 5- to 15-year follow-up for analysis. Results Liner malseating was identified in 20% of cases. Outcomes for 32 cases with Liner malseating (group A) were compared to outcomes for 128 joints with correct Liner seating (group B). The Harris hip score at the last follow-up was 90.1 for group A and 89.6 for group B. Osteolysis was identified in 5 cases in group A (15.6%), compared to 3 cases in group B ( P Conclusion Over a moderate-length follow-up of 5-15 years, malseating of the acetabular Liner was not associated with negative clinical outcomes or THA survivorship. Malseating did increase the incidence of osteolysis, a risk factor for adverse effects. Long-term follow-up studies are needed to fully quantify the effects of malseating of the acetabular Liner.
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a polyethylene Liner scratch after revision hip arthroplasty performed to repair Ceramic fracture
Journal of Arthroplasty, 2012Co-Authors: Yukiharu Hasegawa, Taisuke Seki, Puyi Sheng, Toshiya Kanoh, Atsushi MatsuokaAbstract:A 61-year-old man who had undergone revision total hip arthroplasty in 2000 was evaluated at our clinic in 2008, 1 day after feeling an abnormal clicking sensation in his left hip. Radiographs showed a fracture of the alumina Ceramic Liner of his acetabular component. A second revision total hip arthroplasty was performed with a 28-mm highly crosslinked polyethylene acetabular Liner and an alumina femoral head. Sixteen months after the second revision, the patient experience sudden-onset hip pain. Radiographs revealed a fatigue fracture of the neck of a displaced stem. Analysis by scanning electron microscopy of the surface of the retrieved alumina Ceramic femoral head revealed no scratches or wear, but analysis of the highly crosslinked polyethylene socket revealed third-body wear, scratches, irregularly shaped dips, and white Ceramic particles. Elemental analysis of the white particles by an x-ray microanalyzer revealed the presence of aluminum and oxygen.
Yukiharu Hasegawa - One of the best experts on this subject based on the ideXlab platform.
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incidence of Ceramic Liner malseating after Ceramic on Ceramic total hip arthroplasty associated with osteolysis a 5 to 15 year follow up study
Journal of Arthroplasty, 2017Co-Authors: Yoshitoshi Higuchi, Taisuke Seki, Yukiharu Hasegawa, Daigo Komatsu, Naoki IshiguroAbstract:Abstract Background The aim of our study was to evaluate the clinical and radiographic outcomes of malseating of the acetabular Liner in Ceramic-on-Ceramic total hip arthroplasty (THA). Methods Outcomes for 160 Ceramic-on-Ceramic THAs, contributed by 116 women and 39 men, were evaluated. Clinical and radiographic measurements were obtained over a 5- to 15-year follow-up for analysis. Results Liner malseating was identified in 20% of cases. Outcomes for 32 cases with Liner malseating (group A) were compared to outcomes for 128 joints with correct Liner seating (group B). The Harris hip score at the last follow-up was 90.1 for group A and 89.6 for group B. Osteolysis was identified in 5 cases in group A (15.6%), compared to 3 cases in group B ( P Conclusion Over a moderate-length follow-up of 5-15 years, malseating of the acetabular Liner was not associated with negative clinical outcomes or THA survivorship. Malseating did increase the incidence of osteolysis, a risk factor for adverse effects. Long-term follow-up studies are needed to fully quantify the effects of malseating of the acetabular Liner.
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a polyethylene Liner scratch after revision hip arthroplasty performed to repair Ceramic fracture
Journal of Arthroplasty, 2012Co-Authors: Yukiharu Hasegawa, Taisuke Seki, Puyi Sheng, Toshiya Kanoh, Atsushi MatsuokaAbstract:A 61-year-old man who had undergone revision total hip arthroplasty in 2000 was evaluated at our clinic in 2008, 1 day after feeling an abnormal clicking sensation in his left hip. Radiographs showed a fracture of the alumina Ceramic Liner of his acetabular component. A second revision total hip arthroplasty was performed with a 28-mm highly crosslinked polyethylene acetabular Liner and an alumina femoral head. Sixteen months after the second revision, the patient experience sudden-onset hip pain. Radiographs revealed a fatigue fracture of the neck of a displaced stem. Analysis by scanning electron microscopy of the surface of the retrieved alumina Ceramic femoral head revealed no scratches or wear, but analysis of the highly crosslinked polyethylene socket revealed third-body wear, scratches, irregularly shaped dips, and white Ceramic particles. Elemental analysis of the white particles by an x-ray microanalyzer revealed the presence of aluminum and oxygen.