Ick-Hwan Yang; Chang-Dong Han; Jun-Sang Lee

doi:10.4055/jkoa.2009.44.5.520

Journal List > J Korean Orthop Assoc > v.44(5) > 1012940

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yang, Han, and Lee: Cementless Total Hip Arthroplasty using Ceramic-on-ceramic Osteonics® System: Minimum 8-year Follow up Results

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(5): 520-525.

Published online: 23 September 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.5.520

Cementless Total Hip Arthroplasty using Ceramic-on-ceramic Osteonics® System: Minimum 8-year Follow up Results

Ick-Hwan Yang, M.D., Chang-Dong Han, M.D., Jun-Sang Lee, M.D

Department of Orthopaedic Surgery, Yonsei University College Medicine, Seoul, Korea.

Correspondence to Ick-Hwan Yang, M.D. Department of Orthopaedic Surgery, Gangnam Severance Hospital, Gangnam P.O. Box 1217, Seoul, Korea. Tel: +82.2-2019-3416, Fax: +82.2-573-5393, ihyang@yuhs.ac

Received 20 February 2009 Accepted 18 August 2009

Abstract

Purpose

To evaluate the 8-year follow up results of the clinical and radiographic of the cementless total hip arthroplasty using the Osteonics® system with ceramic-on-ceramic articulation on a retrospective basis.

Materials and Methods

Between March 1999 and February 2000, 31 primary total hip arthroplasties were performed in 27 patients using the cementless Osteonics® system. The mean follow-up period was 101 months (96-107 months). The mean age at surgery was 56.5 years of age (28-62 years). Preoperative diagnoses were the following in the 27 patients: 5 cases of primary osteoarthritis, 15 cases of avascular necrosis, and 7 cases of secondary osteoarthritis. The clinical results were evaluated using the Harris hip score and radiographic evaluation was done in terms of the fixation of components, the prevalence of osteolysis, and wear of ceramics.

Results

The mean preoperative Harris hip score at was the most recent follow-up was 91. Complications were calcar fracture in 8 cases, posterior dislocation in 2 cases, continuous thigh pain in 2 cases, squeaking sound in 3 cases, and limping gait lasting at least 1-year post operation in 6 cases. All cases had fixation by bony ingrowth was and there was no migration of acetabular cups nor osteolysis. There was no loosening of the femoral stem. It was not possible to measure ceramic wear and there were no ceramic fractures.

Conclusion

At the 8-year follow-up, results of the cementless total hip arthroplasty using the Osteonics® system with ceramic-on-ceramic articulation demonstrated favorable results of osseointegration of the components and unmeasurable ceramic wear. However, longer-term-follow up was necessary. We believe that further study is required to determine the high incidence of squeaking.

Keywords: Hip, Total hip arthroplasty, Ceramic-on-ceramic articulation

Figures and Tables

Fig. 1

This photograph shows Osteonics® system with ceramicon ceramic articulation

Fig. 2

Anteroposterior radiograph of 45-year old female patient. (A) Immediate postoperative radiographs shows press-fitted femoral stem and acetabular cup. (B) Eight years follow-up radiograph shows stable components by bony ingrowth.

Table 1

Range of Motion after 8 Years of Clinical Follow-up

References

1. Callaghan JJ, Dysart SH, Savory CG. The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg Am. 1988. 70:337–346.

2. Engh CA, Bobyn JD. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty. Clin Orthop Relat Res. 1988. 231:7–28.

3. Engh CA, Bobyn JD. Biological fixation in total hip arthroplasty. Slack. 1985. 135–189.

4. Kim YH, Kim VE. Cementless porous-coated anatomic medullary locking total hip prosthesis. J Arthroplasty. 1994. 9:243–252.

5. Claus AM, Hopper RH Jr, Engh CA. Fracture of the greater trochanter induced by osteolysis with the anatomic medullary locking prosthesis. J Arthroplasty. 2002. 17:706–712.

6. Dowd JE, Sychterz CJ, Young AM, Engh CA. Characterization of long-term femoral-head-penetration rates. Association with and prediction of osteolysis. J Bone Joint Surg Am. 2000. 82:1102–1107.

7. Wagner M, Wagner H. Medium-term resuts of a modern metal-on-metal system in total hip replacement. Clin Orthop Relat Res. 2000. 379:123–133.

8. Jacobs JJ, Rosenbaum DH, Hay RM, Gitelis S, Black J. Early sarcomatous degeneration near a cementless hip replacement. A case report and review. J Bone Joint Surg Br. 1992. 74:740–744.

9. Langkamer VG, Case CP, Collins C, et al. Tumors around implants. J Arthroplasty. 1997. 12:461–464.

10. Christel PS. Biocompatibility of surgical-grade dense polycrystalline alumina. Clin Orthop Relat Res. 1992. 282:10–18.

11. Garino JP. Modern ceramic-on-ceramic total hip systems in the United States: early results. Clin Orthop Relat Res. 2000. 379:41–47.

12. Kim SY, Kim YG, Yeo JY, Kim DH, Ihn JC. Ceramic on ceramic bearing total hip arthroplasty in young patients with osteonecrosis of femoral head. J Korean Orthop Assoc. 2004. 39:233–238.

13. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969. 91:737–755.

14. 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.

15. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987. 69:45–55.

16. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip arthroplasty. Incidence and a method of classification. J Bone Joint Surg Am. 1973. 55:1629–1632.

17. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976. 121:20–32.

18. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990. 72:518–528.

19. Kawamura H, Dunbar MJ, Murray P, Bourne RB, Rorabeck CH. 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. 83:1333–1338.

20. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990. 257:107–128.

21. Yang IH, Park SH, Han CD. Cementless total hip arthroplasty using ceramic-on-ceramic Summit® System: 3 years follow up. J Korean Hip Soc. 2007. 19:9–15.

22. Yoo MC, Cho YJ, Kim KI, et al. Long term follow up study of cementless total hip arthroplasty for osteonecrosis of the femoral head -Minimum 10-years follow-up study-. J Korean Hip Soc. 2004. 16:1–9.

23. Engh CA Jr, Culpepper WJ 2nd, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg Am. 1997. 79:177–184.

24. Hwang SK, Son YK. The clinical and radioraphic results of primary cementless AML total hip arthroplasties. -Minimun 10-years follow-up study-. J Korean Hip Soc. 1999. 11:142–149.

25. Han CD, Choe WS, Yoo JH. Effect of the polyethylene wear on osteolysis in cementless primary total hip arthroplasty: Minimun 5 years follow-up study. J Korean Orthop Assoc. 1998. 33:746–758.

26. Barrack RL, Jasty M, Bragdon C, Haire T, Harris WH. Thigh pain despite bone ingrowth into uncemented femoral stems. J Bone Joint Surg Br. 1992. 74:63–66.

27. Campbell AC, Rorabeck CH, Bourne RB, Chess D, Nott L. Thigh pain after cementless hip arthroplasty. J Bone Joint Surg Br. 1992. 74:63–66.

28. Morlock WJ, Nassutt R, Janssen R, Wilimann G, Honl M. Mismatched wear couple zirconium oxide and aluminum oxide in total hip arthroplasty. J Arthroplasty. 2001. 16:1071–1074.

29. Walter WL, O'toole GC, Walter WK, Ellis A, Zicat BA. Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplasty. 2007. 22:496–503.

30. Baek SH, Kim SY. Cementless total hip arthroplasty with alumina bearings in patients younger than fifty with femoral head osteonecrosis. J Bone Joint Surg Am. 2008. 90:1314–1320.

TOOLS

Similar articles