Adverse Reaction to Zirconia in a Modern Total Hip Arthroplasty with Ceramic Head
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ABSTRACT:
SUBMITTER: Dawson-Amoah K
PROVIDER: S-EPMC7502561 | biostudies-literature | 2020 Jun
REPOSITORIES: biostudies-literature
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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.
| S-EPMC5485220 | biostudies-literature
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
Project description:BackgroundSqueaking is a known complication of ceramic-on-ceramic (CoC) total hip arthroplasty (THA), yet there is a lack of studies specifically quantifying its loudness. The aims of this study were: (1) to determine the incidence of squeaking in CoC THAs at long-term follow-up; (2) to identify risk factors; and (3) to quantify the loudness of the squeaking.MethodsA specifically designed prospective questionnaire was used to determine the prevalence, characteristics, and loudness of squeaking in 130 (110 patients) primary THAs with fourth-generation CoC bearings at a mean follow-up of 10.5 years. The loudness of the squeaking was determined by the decibel (dB) scale from the Centers for Disease Control and Prevention.ResultsOverall, 28% of the CoC hips experienced squeaking. The mean onset was 5.7 years postoperatively, with 39% of the cases having their onset more than 5 years after their THA. Patients with a lower body mass index were more likely to report squeaking (P = .009). The mean loudness of the squeak was 35 dB (range, 10-70 dB) and was loud in 36% of the hips. Patients who developed squeaking early postoperatively had louder squeaking than those with a later onset (P = .007). The loudness of the squeaking sound progressed in 25% of the cases, and these hips had louder squeaking (P = .04).ConclusionsSqueaking after CoC THA is not uncommon, can be relatively loud, and increases over time. This needs to be considered in young patients that are candidates for CoC THAs.
| S-EPMC10517284 | biostudies-literature
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
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
Project description:The increasing demand for total hip arthroplasty (THA) in relatively young, high-demand patients has led to the use of hard-on-hard bearing surfaces. Adverse local tissue reaction/pseudotumor and elevated serum metal ion levels are commonly reported complications encountered in metal-on-metal THA, while audible articulation and rim fracture are reported in ceramic-on-ceramic THA. For this reason, ceramic-on-metal THA was implemented as an ideal hard-on-hard bearing combination. In this report, we describe a case of bilateral simultaneous ceramic-on-metal THA in a 69-year-old woman who presented 7 years postoperatively with unilateral hip pain associated with underlying pseudotumor and elevated serum cobalt and chromium ion levels. Pre-revision workup, intraoperative findings, and postoperative evaluation are included and suggest acetabular malposition as a potential source for complication.
| S-EPMC5712035 | biostudies-literature
Project description:A 41-year-old woman presented 8 years after a left total hip arthroplasty. She complained of progressive groin pain for several months. Radiographs demonstrated a hard-on-hard bearing surface combination and radiolucent lines surrounding the acetabular shell. Laboratory analysis revealed a mild leukocytosis, a normal erythrocyte sedimentation rate, and a mildly elevated C-reactive protein. Serum cobalt and chromium levels were markedly elevated. Aspiration of the hip joint was negative for infection. Magnetic resonance imaging failed to demonstrate a pseudotumor. Revision total hip arthroplasty was performed, and a ceramic-on-metal bearing surface combination was explanted. Significant intraoperative findings included dark gray synovial fluid, metal transfer onto the ceramic femoral head, and a grossly loose acetabular shell pivoting about a single well-fixed screw. The explanted components otherwise appeared normal macroscopically. Histologic analysis of the capsular tissue demonstrated aseptic lymphocyte-dominated vasculitis-associated lesion and inclusion bodies consistent with third-body wear. Revision arthroplasty to a ceramic-on-polyethylene bearing surface combination was performed with a good clinical result and laboratory normalization at 9-month follow-up.
| S-EPMC4958114 | biostudies-literature
Project description:BackgroundCeramic-on-ceramic bearing surfaces were developed to provide an alternate to metal-on-polyethylene to decrease wear-induced osteolysis in total hip arthroplasty patients. In an effort to decrease the risk of ceramic acetabular component fracture or damage during implantation, a raised metal rim was added.Questions/purposesHow many fractures or impingements have occurred in our population of patients with ceramic liners with raised rims?MethodsWith IRB-approved consent, a case series was reviewed from a single center registry and 4 of 169 patients were identified who had revision hip surgery with the ceramic liner with a raised metal rim: one for ceramic liner fracture and three for metallosis, pain, and squeaking. Implant alignment and operative findings were reviewed.ResultsOne ceramic liner fracture and three cases of metallosis from impingement of the femoral neck on the posterior elevated metal rim of the acetabular liner were observed at revision. The femoral neck in each patient had a divot that corresponded to a divot in the posterosuperior liner rim. Three of the four patients had audible squeaking or clicking prior to revision. A total of 3% of patients in this series had clinically significant impingement with this implant type.ConclusionAcoustic phenomenon in a ceramic on ceramic bearing surface should be investigated with a cross-table lateral radiograph to evaluate component position. If symptomatic impingement is demonstrated, revision should be considered to avoid failure from metallosis or fracture.
| S-EPMC4342397 | biostudies-literature
Project description:BACKGROUND:Head breakage is a serious complication following total hip arthroplasty when using Ceramic on Ceramic bearings surfaces. There is still in controversy about the selection of bearing surfaces when conducting revision surgery. CASE PRESENTATION:We describe the case of a fifty-year-old man who had undergone right total hip arthroplasty (THA) with ceramic-on-ceramic prostheses in 2011. After a fall 6 years after the primary procedures, radiographs suggested a ceramic head breakage for revision THA with exchange of metal-on-polyethylene bearing. However, 8 months later, severe metallosis and multiple pseudotumor was confirmed in pelvis and surrounding hip after re-revision THA with ceramic-on-polyethylene prostheses. Analysis of the serum metal ion indicated massive wear of the metal head and erosion of the stem neck and taper. CONCLUSIONS:This case vividly demonstrates metal bearings should be avoided and revision with complete synovectomy and thorough debridement should be performed whenever possible for a fractured ceramic bearing.
| S-EPMC6637575 | biostudies-literature
Project description:The 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.A 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.The 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.This 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-other