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Adverse Reaction to Zirconia in a Modern Total Hip Arthroplasty with Ceramic Head.

ABSTRACT: Hypersensitivity reactions to zirconia (ZrO2) or similar ceramics is highly unusual. Owing to the stable oxide formed between the base metal and oxygen, ceramics are considered relatively biologically inert. We report the case of an otherwise healthy 50-year-old woman with a 5-year history of progressively worsening right hip pain who underwent a ceramic-on-polyethylene total hip replacement and subsequently developed hypersensitivity reaction. After metal allergy testing showed her to be highly reactive to zirconium, the femoral head was revised to a custom titanium implant and her symptoms resolved.

SUBMITTER: Dawson-Amoah KG

PROVIDER: S-EPMC7502561 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Adverse Reaction to Zirconia in a Modern Total Hip Arthroplasty with Ceramic Head.

Dawson-Amoah Kwesi G KG Waddell Bradford S BS Prakash Rohan R Alexiades Michael M MM

Arthroplasty today 20200619 3

Hypersensitivity reactions to zirconia (ZrO2) or similar ceramics is highly unusual. Owing to the stable oxide formed between the base metal and oxygen, ceramics are considered relatively biologically inert. We report the case of an otherwise healthy 50-year-old woman with a 5-year history of progressively worsening right hip pain who underwent a ceramic-on-polyethylene total hip replacement and subsequently developed hypersensitivity reaction. After metal allergy testing showed her to be highly ...[more]

PMID: 32995410

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Adverse Local Tissue Reaction and Osteolysis After Ceramic-on-Ceramic Total Hip Arthroplasty.

Project description:Adverse local tissue reaction (ALTR) and osteolysis formation are more frequently described complications after total hip arthroplasty (THA) with metal-on-metal bearings. In this report, we present a unique case of ALTR and osteolysis formation with ceramic-on-ceramic bearing THA, which has been less commonly described in the existing literature. This rare case occurred in a 54-year-old patient who had a primary THA done 17 years prior to representing to our institution. As part of the workup for our patient to find out the underlying cause of his complications, we have carried out extensive investigations that have not been previously reported. We conclude that ceramic bearings in THA may not be entirely inert and may cause complications such as osteolysis and ALTR.

| S-EPMC11665469 | biostudies-literature

An Atypical Adverse Local Tissue Reaction After Ceramic-on-Ceramic Primary Total Hip Arthroplasty.

Project description:Adverse local tissue reaction is an uncommon but frequently described complication after total hip arthroplasty (THA). It is most often associated with metal-on-metal hips and less frequently with metal-on-polyethylene implants as part of a mechanically assisted crevice corrosion process. In this report, we describe a rare case of an atypical adverse local tissue reaction in a patient with a ceramic-on-ceramic THA. Abrasive backside liner wear from a prominent screw head, failure of the liner locking mechanism, and liner fragmentation secondary to component-component impingement created an atypical mass and fluid collection leading to THA failure. This case demonstrates the importance of appropriate cup-liner positioning, thorough workup of pain after THA, and the ability of ceramic debris to cause an associated, atypical adverse local tissue reaction.

| S-EPMC8889265 | biostudies-literature

Femoral Nerve Compression due to Adverse Local Tissue Reaction After Ceramic-on-ceramic Total Hip Arthroplasty

Project description:The use of metal bearings in total hip arthroplasty (THA) has been linked with adverse local tissue reactions (ALTRs). There is 1 reported case of ALTR from a ceramic-on-ceramic (CoC) bearing and none that resulted in nerve compression. In this case, a 71-year-old man presented with an ALTR after a CoC THA that resulted in femoral nerve compression. An anterior approach was utilized to revise his THA, which resulted in nerve decompression and near-resolution of his preoperative symptoms. We conclude that CoC bearings may not be completely inert and can result in ALTRs and nerve compression.

| S-EPMC9713287 | biostudies-literature

Osteosarcoma Around a Ceramic-on-Ceramic Total Hip Arthroplasty.

Project description:Sarcoma arising at the site of a total hip arthroplasty (THA) is uncommon. We present a case report of a patient diagnosed with an osteosarcoma around a ceramic-on-ceramic THA and a narrative literature review of sarcomas around THA. A search of PubMed MEDLINE was performed from inception. Our case report was included in the analysis. A total of 13 studies were included in the review. We report the first case of a sarcoma around a ceramic-on-ceramic hip implant. All cases in the literature reported poor outcomes with an average time from index THA to diagnosis of 9.3 ± 8.2 years. Sarcomas around THA are extremely rare. Despite the rarity of the diagnosis, osteosarcoma must be considered in the differential diagnosis when investigating a periprosthetic mass.

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Project description:We present a unique case of a symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface. To our knowledge, this pathological finding has not yet been described in a ceramic-on-ceramic articulation without a cobalt-chromium alloy trunnion or modular neck component as a source of metal wear. We conclude that despite its mechanical mostly benign wear characteristics, ceramic wear debris is not entirely inert and may lead to the development of adverse local tissue reaction.

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Ceramic-on-Ceramic Total Hip Arthroplasty: I Can Hear You

Project description: Not available

| S-EPMC10517284 | biostudies-literature

Ceramic-on-ceramic bearings total hip arthroplasty in young patients.

Project description:BackgroundThe results of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in younger patients were not univocal. This study aims to evaluate the results of CoC bearing THA in patients younger than 50 years.MethodsA total of 90 younger patients performed CoC THAs during March 2003 and May 2008 were included in this study. Hip function and activity were evaluated with Harris hip score and University of California Los Angeles activity score. We had discussed survival rates, radiological findings of component loosening or osteolysis, and ceramic-related complications in these patients.ResultsThe mean Harris hip score increased from 46.3 ± 12.0 points (range, 28-70 points) before surgery to 92.5 ± 5.6 points (range, 78-100 points) at the final follow-up. The mean preoperative University of California Los Angeles activity score was 4.2 ± 1.1 points (range, 2-6 points), which improved to a mean of 7.2 ± 1.3 points (range, 4-10 points). At the time of the last follow-up, there was found to be 1 occurrence of hip dislocation, 1 squeaking, and 2 "sandwich" ceramic liners fractured during normal activity of daily living. No hips showed osteolysis or required revision for aseptic loosening. Kaplan-Meier survivorship with revision due to loosening or osteolysis was 100% and with revision due to ceramic fracture was 97.3% (95% confidence interval, 93.7%-100%) at a mean of 9.4 years.ConclusionsThis study with the use of CoC bearings THAs in younger patients have shown promising results and higher rate of survivorship without evidence of osteolysis.

| S-EPMC5247519 | biostudies-literature

Incidence of 'squeaking' after ceramic-on-ceramic total hip arthroplasty.

Project description:UnlabelledThe incidence of hip "squeak" associated with ceramic-on-ceramic bearings has been variably reported, ranging from 0.7% to 20.9%. We determined the patients' perception of squeaking in 306 patients (336 hips) in whom ceramic-on-ceramic total hip arthroplasties (THAs) were performed between 1997 and 2005. A questionnaire regarding hip noise was obtained by telephone. With a minimum followup of 2 years (mean, 3.9 years; range, 2-10 years), 290 patients (320 or 95% of the THAs) completed the questionnaire. Patients reported hip noise in 55 of the 320 THAs (17%); noise was perceived as squeak in 32 of the 320 (10%). Most squeaking hips (29 of 32) were pain-free and symptom-free. One patient was unhappy with his squeaking hip without pain. Our data suggest a much higher incidence of squeak as perceived by patients than previously reported.Level of evidenceLevel II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

| S-EPMC2806984 | biostudies-literature

Adverse Local Tissue Reaction Associated With Ceramic-On-Metal Bearing Surface in Primary Total Hip Arthroplasty: Report of Two Cases.

Project description:Total hip arthroplasty (THA) is one of the most common and successful surgical procedures worldwide. At the same time, it is constantly evolving, and as a consequence, advances in implant technology have led to significant improvements in the different materials of the acetabular and femoral components. The selection of bearing surfaces and their tribology are critical to achieving a successful outcome. Pseudotumors are important, and usually misdiagnosed, complications associated with hard bearing surfaces such as metal-on-metal couples. They belong to a group of reactions called adverse local tissue reaction, which can occur in the vicinity of any THA. We present 2 cases of adverse local tissue reaction associated with the use of ceramic-on-metal bearings surfaces in 2 primary THAs that were treated with modular component exchange during single-stage revision surgery.Level of evidenceIV.

| S-EPMC9157011 | biostudies-literature

Long-Term Results of Delta Ceramic-on-Ceramic Total Hip Arthroplasty.

Project description:BackgroundCeramic-on-ceramic (COC) bearings in total hip arthroplasty (THA) have long been considered the coupling with the lowest overall wear. However, concerns about complications such as ceramic breakage and noise, combined with the improved performance of polyethylene, have limited its use in the United States. This postapproval follow-up reports long-term (10 years) results of Delta COC in THA patients primarily enrolled in an Investigational Device Exemption study.MethodsPatients received Delta COC THA in a prospective multicenter study with either 28-mm (N = 105 hips in 104 patients) or 36-mm (N = 81) articulations. Annual clinical and radiographic evaluations were performed for years 5 to 10, and study patients were asked about hip noises and reproducibility.ResultsThere have been 4 additional reports of noise in 4 patients (COC 28, n = 3; COC 36, n = 1). The cumulative incidence rate for squeaking or noise at 10 years is 5.9% for COC 28 and 13.5% for COC 36. There have been 2 additional reports of dislocation in 2 patients (COC 28, n = 1; COC 36, n = 1). The cumulative incidence rate for dislocation at 10 years is 3.7% for COC 28 and 3.5% for COC 36. At 10 years, there were greater than 40 hips available for follow-up. At mean 10-year follow-up, there were a total of 3 ceramic liner fractures, but none since the previous report. There were no revisions in the 28-mm cohort, and 2 revisions in the 36-mm cohort (1 for recurrent dislocation and 1 for pain and noise). Overall Kaplan-Meier survivorship was 95.96% at 10.5 years (28 mm: 97.68% at 10.2 years; 36 mm: 94.11% at 10.4 years.).ConclusionsAt 10-year follow-up, we report excellent results in regard to survivorship, with one patient revised for pain with associated squeaking.

| S-EPMC8784293 | biostudies-literature

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