Figure - available from: Journal of Orthopaedic Surgery and Research
This content is subject to copyright. Terms and conditions apply.
Top-left: scheme showing contact points between neck taper and ceramic liner after ceramic head fracture. Top-right: metal transfer due to impingement between taper tip and ceramic liner. EDX spectrum revealed that smears are made of Ti-alloy. Bottom-left: scratches found on the lateral side of the modular neck. EDX spectrum revealed small ceramic particles embedded into the metal. Bottom-right: chipping of the ceramic liner. EDX spectrum revealed that smears and particles on the fracture surface are made of Ti-alloy
Source publication
Background
Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has contributed to the decrease in fracture rate, at leas...
Citations
... Improper impaction of the femoral head prosthesis during surgery has also been identified as a potential risk factor for ceramic head fracture (43). Although the use of fourth-generation ceramics significantly improves the Frontiers in Surgery material's resilience, making it less prone to brittle fracture, orthopedic surgeons still need to pay attention to obtaining proper head seating on a clean taper during femoral head assembly as a prerequisite to reduce the risk of any damage occurring at the head-taper junction (44). The surgeon's clinical experience and expertise play a crucial role in ensuring the success of the surgery and the safety of the patient. ...
Background
Ceramic fragmentation is a rare but serious complication after total hip arthroplasty (THA). We reviewed the PubMed literature from 1990 to 2023 and found only 31 case reports of ceramic fragmentation after THA. Our case reports help to expand understanding of this rare complication. We shared our surgical experience and identified an ideal material for revision surgery, which can serve as a useful reference for other orthopedic surgeons to perform ceramic fragmentation revision surgery in the future. We also analyzed the possible causes, diagnosis, and treatment opinions of ceramic fragmentation.
Case presentation
This study presents two cases of ceramic fragmentation after THA. One patient had ceramic head fragmentation 10 years after the primary THA, and one patient had ceramic liner fragmentation 5 years after the primary THA. Both patients presented with pain, and one patient also reported a clicking sound in the hip. The two patients described here had BMIs of 23.7 and 23.1, respectively. Both patients' ceramic fragmentation were due to aseptic loosening, not periprosthetic joint infections, as confirmed by negative microbiological cultures. Radiographic examinations of both patients revealed radio-opaque wear debris around the hip joint prostheses and we describe the surgical protocols and intraoperative findings in both cases in detail.
Conclusion
Our cases and the literature suggest that ceramic fragmentation can occur at any time after THA. The most immediate symptoms are pain and noise, but some patients may be asymptomatic. Ceramic on polyethylene bearings is recommended for revision surgery whenever possible; metal bearings should be avoided.
... Поколение «Biolox Delta» проявило себя отлично в среднесрочный период [10,11]. Так, раскол керамических головок значительно снизился [10,12], но раскол вкладыша оставался на таком же уровне, составляя до 0,03 % [13]. В процентном соотношении результаты могут показаться клинически не значимыми, но последствия раскола керамики катастрофичны по следующей причине [9,11] -керамические компоненты пары трения, разрушенные по тем или иным причинам, не рекомендуется менять на иные, менее хрупкие материалы, а следует вновь вернуться к керамической паре трения, в связи с тем, что керамический дебрис и третье тело, остающиеся в окружающих мягких тканях в результате раскола, в дальнейшем могут проникнуть в трущуюся поверхность пары трения и разрушить ее, если она мягче, чем керамика [11,14,15]. ...
... Lucchini S. и соавт. предложили гипотезу многоступенчатого раскола керамики, предполагая, что раскол -это не одномоментное событие, а следствие длительного процесса [12], течение которого, теоретически, можно прогнозировать. ...
... Шум при функционировании эндопротезов с керамической парой трения может стать предиктором риска разрушения [83]. Недавнее исследование продемонстрировало, что разрушение керамических компонентов происходит чаще из-за постоянных воздействий определенных сил, нежели в результате одномоментной травмы [12]. Lévêque R. и соавт. ...
Introduction Ceramic hip replacement bearings have shown to be low wearing and biocompatible. The last two generations of Biolox Forte and Biolox Delta ceramics have have established themselves as durable bearings. However, squeaking and noise from ceramic bearing THRs is well recognised in the 21st century.
The objective was to explore the problem of noise in the ceramic bearing of THA based on the analysis of the foreign and Russian literature.
Material and methods In presented the analysis of Foreign and Russian literature searches for the review were produced according to PRISMA recommendations using PubMed, Scopus, Google Scholar, eLibrary. MINOR was used to assess the methodological quality of articles.
Results and Discussion Noise in ceramics is observed in 37.7 %. There are many theories on the origin and mechanism of noise including liner impingement and loading, film disruption, third body, microseparation and resonance. However, there is still no consensus on what is noise in the ceramic bearing and how to solve this problem.
Conclusion Literature review of ceramic bearing indicated enough unanswered questions. The noise may play a role as a predictor of improper use of endoprosthesis with accumulated database resulting in better understanding of the phenomenon, methods of the correction and timely prevention of ceramic breakage.
... GPa and 18.51 GPa respectively. This predicted tensile stress exceeded the flexural strength of the material by a significant amount causing contact-induced local inelastic deformation in ceramics, as reported (Guiberteau et al., 1994;Lucchini et al., 2022). Still, the optimum mesh size to be considered for dynamic edge loading condition seems unresolved due to edge geometrical singularity. ...
Hard-on-Hard hip implants, specifically ceramic tribo-pair, have produced the highest in-vivo wear resistance, biocompatibility, superior corrosion resistance, and high fracture toughness. However, this ceramic tribo-pair suffers from edge loading, sharply increasing wear and accelerating early implant failures due to micro-separation. Even though in-vitro studies have tested the occurrence of wear due to dynamic edge loading, the Finite Element Method (FEM) gives the advantage of accurately estimating the wear, minimizing the experimental time and cost. A new fundamental FEM model is developed to predict wear for ceramic hip replacement bearings under dynamic edge loading conditions for a fixed separation and fixed inclination angle. The model is directly validated with the existing hip simulator data up to 3 million cycles in terms of wear depth, wear scar and volumetric wear rate. The results from the model show that the accuracy in wear prediction was more than 98% for the wear depth and volumetric wear rate for the dynamic edge loading condition. A stripe wear scar is captured, depicting the edge loading conditions. The developed model from this study can predict wear under pure standard and dynamic edge loading conditions.
Purpose
Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II–IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II–IV JARs must be created to effectively assess and categorize these data.
Methods
Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II–IV JARs worldwide. The secondary aim was to record their lifetime, publications’ number and frequency and recognise differences with national JARs.
Results
One hundred five Level II–IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case–control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies.
Conclusions
This is the first study mapping all Level II–IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
