J Korean Orthop Assoc.  2011 Dec;46(6):478-483.

The Third Generation Alumina-on-Alumina Bearing Total Hip Arthroplasty in Patients Under the Age of Forty: A Minimum Five-Year Follow Up Study

• Kim YS
• Kim SJ
• Hwang KT
• Choi IY
• Kim YH

Abstract

PURPOSE
We investigated the results of the third generation alumina on alumina bearing total hip arthroplasty in patients under the age of forty.
MATERIALS AND METHODS
Fifty patients (57 hips) under the age of forty, who had uncemented total hip arthroplasty using third generation alumina bearing, between April 2000 and March 2006 were observed. The group consisted of 24 men and 26 women. The average age at the operation was 30.3 years (18-39 years). The average follow up period was 8.0 years (5-11 years). The most common cause for surgery was rheumatoid arthritis. We assessed the clinical and radiological results and postoperative complications.
RESULTS
The mean Harris hip score at the last follow-up was 96 points on average. There was no inguinal pain. However, there were two hips of which the patient was experiencing thigh pain. One hip with squeaking was observed. We could observe the stable bony fixation of implants in all hips. There were no aseptic loosening and no osteolysis around the implants. Postoperative complications included one hip with nonunion of trochanteric osteotomy and one hip with dislocation. There were no ceramic fractures, no postoperative infections and no revisions.
CONCLUSION
We observed the favorable clinical and radiographic outcomes of the third generation alumina on alumina total hip arthroplasty in patients under the age of forty. However, in the case of squeaking, a longer term follow-up is needed.

Keyword

total hip replacement; alumina ceramic; squeaking; young age

MeSH Terms

Aluminum Oxide
Arthritis, Rheumatoid
Arthroplasty
Arthroplasty, Replacement, Hip
Ceramics
Dislocations
Female
Femur
Follow-Up Studies
Hip
Humans
Male
Osteolysis
Osteotomy
Postoperative Complications
Thigh
Ursidae
Aluminum Oxide
Ceramics

Figure

• 

  Figure 1 Radiographs of a 20-year-old male patient who complained of a noise (squeaking) from right hip joint. (A) The inclination angle in anteroposterior view was 53°. (B) The anteversion angle in lateral view was 10°. The squeaking did not disturb his daily activity and close observation has been performed.

• 

  Figure 2 (A) A hip AP radiograph taken at postoperative 2 weeks of a 22-year-old female patient, who underwent the third generation alumina-on-alumina total hip arthroplasty, shows sound fit cup and stem. (B) Radiographs of hip AP and lateral view taken at postoperative 11 years show no evidence of periprosthetic osteolysis or loosening.

Reference

1. Harris WH. Wear and periprosthetic osteolysis: the problem. Clin Orthop Relat Res. 2001. (393):66–70.

2. Eskelinen A, Remes V, Helenius I, Pulkkinen P, Nevalainen J, Paavolainen P. Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years. Acta Orthop. 2005. 76:28–41.

3. Muratoglu OK, Bragdon CR, O'Connor DO, Jasty M, Harris WH. A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties. Recipient of the 1999 HAP Paul Award. J Arthroplasty. 2001. 16:149–160.

4. Weber BG. Experience with the Metasul total hip bearing system. Clin Orthop Relat Res. 1996. (329 Suppl):S69–S77.

5. Boutin P, Christel P, Dorlot JM, et al. The use of dense alumina-alumina ceramic combination in total hip replacement. J Biomed Mater Res. 1988. 22:1203–1232.

6. Skinner HB. Ceramic bearing surfaces. Clin Orthop Relat Res. 1999. (369):83–91.

7. Yoo JJ, Kim YM, Yoon KS, et al. Alumina-on-Alumina THA in active patients younger than 40 years old: a 5-year minimum follow-up study. J Korean Orthop Assoc. 2006. 41:404–412.

8. Mahoney OM, Dimon JH 3rd. Unsatisfactory results with a ceramic total hip prosthesis. J Bone Joint Surg Am. 1990. 72:663–671.

9. Barrack RL, Burak C, Skinner HB. Concerns about ceramics in THA. Clin Orthop Relat Res. 2004. (429):73–79.

10. 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.

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

12. 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.

13. 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.

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

15. Sedel L, Kerboull L, Christel P, Meunier A, Witvoet J. Alumina-on-alumina hip replacement. Results and survivorship in young patients. J Bone Joint Surg Br. 1990. 72:658–663.

16. Ha YC, Koo KH, Jeong ST, Joon Yoo J, Kim YM, Joong Kim H. Cementless alumina-on-alumina total hip arthroplasty in patients younger than 50 years: a 5-year minimum follow-up study. J Arthroplasty. 2007. 22:184–188.

17. Visuri TI, Pukkala E, Pulkkinen P, Paavolainen P. Cancer incidence and causes of death among total hip replacement patients: a review based on Nordic cohorts with a special emphasis on metal-on-metal bearings. Proc Inst Mech Eng H. 2006. 220:399–407.

18. Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum. 2000. 43:522–530.

19. Garcia-Rey E, Cruz-Pardos A, Garcia-Cimbrelo E. Alumina-on-alumina total hip arthroplasty in young patients: diagnosis is more important than age. Clin Orthop Relat Res. 2009. 467:2281–2289.

20. Wang BC, Lee TM, Chang E, Yang CY. The shear strength and the failure mode of plasma-sprayed hydroxyapatite coating to bone: the effect of coating thickness. J Biomed Mater Res. 1993. 27:1315–1327.

21. D'Antonio JA, Capello WN, Manley MT, Geesink R. Hydroxyapatite femoral stems for total hip arthroplasty: 10- to 13-year followup. Clin Orthop Relat Res. 2001. (393):101–111.

22. Delank KS, Drees P, Menzel N, Hansen T, Duschner H, Eckardt A. Increased polyethylene wear after cementless ABG I total hip arthroplasty. Arch Orthop Trauma Surg. 2006. 126:509–516.

23. Duffy P, Sher JL, Partington PF. Premature wear and osteolysis in an HA-coated, uncemented total hip arthroplasty. J Bone Joint Surg Br. 2004. 86:34–38.

24. Røkkum M, Reigstad A, Johansson CB. HA particles can be released from well-fixed HA-coated stems: histopathology of biopsies from 20 hips 2-8 years after implantation. Acta Orthop Scand. 2002. 73:298–306.

25. Stilling M, Rahbek O, Søballe K. Inferior survival of hydroxyapatite versus titanium-coated cups at 15 years. Clin Orthop Relat Res. 2009. 467:2872–2879.

26. Daugaard H, Elmengaard B, Bechtold JE, Soballe K. Bone growth enhancement in vivo on press-fit titanium alloy implants with acid etched microtexture. J Biomed Mater Res A. 2008. 87:434–440.

27. Choi IY, Kim YS, Hwang KT, Kim YH. Incidence and factors associated with squeaking in alumina-on-alumina THA. Clin Orthop Relat Res. 2010. 468:3234–3239.

28. Walter WL, Waters TS, Gillies M, et al. Squeaking hips. J Bone Joint Surg Am. 2008. 90:Suppl 4. 102–111.

29. Keurentjes JC, Kuipers RM, Wever DJ, Schreurs BW. High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res. 2008. 466:1438–1443.

30. Chevillotte C, Trousdale RT, Chen Q, Guyen O, An KN. The 2009 Frank Stinchfield Award: "Hip squeaking": a biomechanical study of ceramic-on-ceramic bearing surfaces. Clin Orthop Relat Res. 2010. 468:345–350.