Do-Hyun Moon; Nam-Ki Kim; Il-Whan Wang; Sang-Jin Lee; Jang-Seok Choi

doi:10.5371/hp.2014.26.1.14

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Moon, Kim, Wang, Lee, and Choi: Primary Cementless Total Hip Arthroplasty with a Ceramic Sandwich Liner and a Third Zweymüller Stem: Minimum 8-Year Follow up Results

Original Article

Hip & Pelvis 2014; 26(1): 14-21.

Published online: 31 March 2014

DOI: https://doi.org/10.5371/hp.2014.26.1.14

Primary Cementless Total Hip Arthroplasty with a Ceramic Sandwich Liner and a Third Zweymüller Stem: Minimum 8-Year Follow up Results

Do-Hyun Moon, MD, Nam-Ki Kim, MD, Il-Whan Wang, MD, Sang-Jin Lee, MD, Jang-Seok Choi, MD

Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea.

Address reprint request to Jang-Seok Choi, MD. Department of Orthopedic Surgery, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea. TEL: +82-32-460-3384, FAX: +82-32-468-5437, chlwkdtjr@hanmail.net

Received 20 January 2014 Revised 10 March 2014 Accepted 10 March 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to evaluate the minimum eight-year follow up results of primary total hip arthroplasty (THA) performed using an alumina sandwich liner and the third Zweymüller stem.

Materials and Methods

A total of 86 patients (107 hips) who underwent a THA with alumina sandwich liners and the third Zweymüller stems from July 2001 to December 2003 were analyzed. Mean age of patients at the time of THA was 50.8 years (range, 17-77 years) and the mean follow-up period was 112 months (range, 98-127 months). Clinical evaluation was performed using the Harris hip score and level of thigh pain. The radiographic evaluation was performed in terms of the radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening.

Results

At the final follow-up, mean Harris hip score had improved from 57.8 points to 91.9 points. Radiolucent line was observed at Gruen zone 1 in 40 cases (37%) and at zone 7 in 35 cases (33%); however, no detectable loosening was observed. There were six cases (5.6%) of fracture of the ceramic liner, one case of ceramic liner dissociation, and one case of stem loosening due to infection.

Conclusion

At the minimum eight-year follow up, survival rate of the third Zweymüller stem was 99.1%. However, owing to the high rate of fractures of the ceramic sandwich liners, the survival rate of the ceramic liner was 93.5%.

Keywords: Total hip arthroplasty, Ceramic sandwich liner, Zweymüller stem

Figures and Tables

Fig. 1

(A) Radiographs show broken pieces around femoral stem (arrows). (B) Photographs show a fractured ceramic liner. Ceramic liner was broken in mutiple pieces. (C) Radiographs after acetabular cup, polyethylene liner and ceramic head changed.

Fig. 2

(A) Anteroposterior radiograph shows a dissociated ceramic liner from polyethylen (arrow). (B) Lateral radiograph shows a dissociated ceramic liner from polyethylen (arrow). (C) Photographs showing a dissociated ceramic liner. Ceramic liner was not broken.

Fig. 3

(A) Anteroposterior radiograph after acetabular cup, polyethylene liner and ceramic head changed. (B) Translateral radiograph after acetabular cup, polyethylene liner and ceramic head changed.

Fig. 4

Survivorship analysis with sandwich liner removal for any cause as endpoint.

Fig. 5

Survivorship analysis with femoral stem removal for any cause as endpoint.

Table 1

Comparison between Broken Liner Group and Control Group

^*Mann-Whitney test.

Table 2

Demographic Factors of Broken Sandwich Liner

AVN: avascular necrosis, RA: rheumatoid arthritis

^*Liner dissociation.

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