Seminars in Arthroplasty RSS feed: Current Issue. Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice. 2009 Issues/Topics February Current Concepts in Hip and Knee Replacement A. Seth Greenwald May Current Concepts in Shoulder Replacement A. Seth Greenwald August Disorders and Treatment of the Patellofemoral Joint David Hungerford December TBD http://www.semarthroplasty.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Seminars in Arthroplasty1045-4527224December 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semarthroplasty.com/article/PIIS1045452711001301/abstract?rss=yesEditorial Board10.1053/S1045-4527(11)00130-1Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6iihttp://www.semarthroplasty.com/article/PIIS1045452711001325/abstract?rss=yesContents10.1053/S1045-4527(11)00132-5Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6iiiiihttp://www.semarthroplasty.com/article/PIIS1045452711001313/abstract?rss=yesIssue Topics10.1053/S1045-4527(11)00131-3Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6ivivhttp://www.semarthroplasty.com/article/PIIS104545271100126X/abstract?rss=yesThis fourth quarter issue of Seminars in Arthroplasty represents an outgrowth of a symposium on ceramic articulations held in conjunction with the 27th Annual Current Concepts in Joint Replacement—Winter meeting, which occurred last December in Orlando, Florida. Its continuing purpose is to describe the increasing clinical utility of ceramics as bearing surface choices for both hip and knee arthroplasty applications. Their employ manifestly extends the concept of the low-friction arthroplasty advanced by Sir John Charnley as a solution for degenerative joint disease to younger and more active patient populations.IntroductionA. Seth Greenwald10.1053/j.sart.2011.10.007Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6213213http://www.semarthroplasty.com/article/PIIS1045452711001222/abstract?rss=yesSir John Charnley, in the early 1960s, began the orthopedic revolution of joint replacement surgery with his low-friction arthroplasty. Years earlier, he had been unsuccessful with a similar design, but with an inferior material, Teflon. Although the use of medical-grade polyethylene seemed to provide good midterm results, there were a number of individuals who had some doubt about the durability of this metal-on-plastic combination developed by Charnley. McKee was concerned with polyethylene and developed a metal–metal hip replacement in the mid 1960s. Other substitute materials for the polyethylene were sought, and in 1970, the Parisian, Boutin, performed the first ceramic–ceramic total hip replacement.Ceramic Hip Replacement HistoryJonathan P. Garino10.1053/j.sart.2011.10.003Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6214217http://www.semarthroplasty.com/article/PIIS1045452711001106/abstract?rss=yes Bearing surfaces are an important implant-related factor in the process of wear and resulting osteolysis. Especially, polyethylene (PE) wear is known to be a major reason for aseptic loosening of the acetabular and femoral components in total hip replacement (THR). In the past, several studies showed the advantages of ceramic femoral ball heads compared with metal ball heads with respect to the resulting PE wear. In this framework, we posed the question whether ceramic and metal ball heads still resulted in similar clinical outcome regarding PE wear after 20-year follow-up. Additionally, we investigated whether wear and osteolysis were correlated within these groups and compared our findings with results from appropriate publications. In this prospective study, 93 nonselected, consecutive uncemented hip arthroplasties were performed in 80 patients with use of the titanium-coated Robert Mathys (RM) cup and the cementless Spotorno stem. Eighty ceramic and 13 metal femoral heads with a diameter of 32 mm were used. The mean age of the patients was 52 years. The average follow-up was 19.3 years. No patient was lost for follow-up. The metal group showed a mean wear rate of 0.190 mm/year, whereas the ceramic group had 0.107 mm/year (P = 0.025). The rate of revision cases was clearly higher within the CoCrMo group showing 6 revisions in 13 cases (46.2%) compared with 11 in 80 cases (13.8%) within the ceramic group. Wear rates were positively correlated to femoral head material (P = 0.025), stem osteolysis (P = 0.003), cup osteolysis (P = 0.011), cup revision (P = 0.041), and cup inclination (P = 0.012). This long-term study shows that during a period of 20 years, ceramic ball heads generate less linear PE wear compared with metal ball heads, thus causing significantly less osteolysis and revisions of either component. Ceramic Versus Metal Femoral Heads in Combination With Polyethylene Cups: Long-Term Wear Analysis at 20 YearsMartin Ihle, Sabine Mai, Werner Siebert10.1053/j.sart.2011.09.001Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6218224http://www.semarthroplasty.com/article/PIIS1045452711001118/abstract?rss=yes We hypothesized that large ceramic head articulation against highly cross-linked polyethylene in young and active patients would have high safety for dislocation and fracture and low wear rates. Wear analysis of 32 hips with 36-mm Delta ceramic femoral heads (CeramTec, Plochingen, Germany) on highly cross-linked polyethylene was performed using Roman software (Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom). The mean age was 56.8 ± 6.5 years, and the mean follow-up was 2.6 ± 0.5 years. The mean wear rate was 0.022 ± 0.11 mm/year after the bedding-in period. There were no reoperations. The early results of large ceramic heads in young and active patients demonstrate high safety and efficacy. Short-term Wear Analysis and Clinical Performance of Large Ceramic Heads on Highly Cross-linked Polyethylene in Young and Active PatientsMorteza Meftah, Prouskeh Bruce Ebrahimpour, Chuan He, Amar S. Ranawat, Chitranjan S. Ranawat10.1053/j.sart.2011.09.002Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6225228http://www.semarthroplasty.com/article/PIIS104545271100112X/abstract?rss=yes Recent technologic advances in total hip arthroplasty (THA) have focused on improving the longevity and wear characteristics of bearing surfaces that can withstand the high demands of younger and more active patients. Recent reports of early failures of metal-on-metal THA have introduced doubts to its ability to be a viable long-term hard-on-hard bearing surface for hip arthroplasty. Like metal-on-metal, ceramic-on-ceramic (COC) bearing surfaces have excellent in vitro wear characteristics, but there is little information about their long-term track record in vivo, particularly in those patients who are younger and more active. The purpose of this study is to evaluate the long-term outcomes of COC THA in active patients younger than 50 years of age. We retrospectively reviewed 82 consecutive THAs in 64 patients performed by a single surgeon from 1997 to 2000. There were 42 men and 22 women with an average age of 38.6 years. Of the 82 THAs, 39 were performed for avascular necrosis of the hip, 30 for osteoarthritis, 8 for developmental dysplasia, and 5 for inflammatory or posttraumatic arthritis. Clinical outcomes were evaluated using the Harris hip score, and serial radiographs were evaluated for signs of component loosening. The mean follow-up period was 10.1 (range, 10.0-12.3) years. One patient died, and another was lost to follow-up. The mean Harris hip score was 89.8. There were no implants with subsidence or circumferential radiolucent lines. Two patients required revision surgery of their THA for a ceramic liner fracture. One patient complained of squeaking that required revision. There were no cases of revision for ceramic head fracture, instability, or aseptic loosening. At a minimum 10-year follow-up, the survivorship of the COC THA was 96.3%. Modern COC THA in active patients younger than 50 years of age is durable at a minimum 10-year follow-up; however, patients should be advised of the small chance of squeaking and ceramic fracture. Ten-Year Follow-Up of Patients Younger Than 50 Years With Modern Ceramic-on-Ceramic Total Hip ArthroplastyJason E. Hsu, Stuart D. Kinsella, Jonathan P. Garino, Gwo-Chin Lee10.1053/j.sart.2011.09.003Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6229233http://www.semarthroplasty.com/article/PIIS1045452711001131/abstract?rss=yes Ninety-five ceramic-on-ceramic hips from a single center were reviewed to investigate whether patients' postoperative UCLA activity level of 9 or 10 in the ensuing 9-14 years following surgery negatively affected long-term radiographic and clinical outcome compared with those with less aggressive activity. Ten patients (10 hips) reported level 9-10 scores at some time after their replacement. Six of these had current radiographs. No patients had loosening, impending loosening, or component failure. Of 6 patients, 3 (50%) had at least one proximal femoral zone of radiolucent lines. This is in contrast with 2 of 39 (5.1%) in those with an activity score of 8 or less. Does High-Activity Behavior Compromise Outcome at a 9-14-Year Interval Following a Ceramic-on-Ceramic Total Hip Arthroplasty? A Preliminary ReportJ. Wesley Mesko, Sara Heath10.1053/j.sart.2011.09.004Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6234239http://www.semarthroplasty.com/article/PIIS1045452711001143/abstract?rss=yes The ceramic-on-ceramic bearing couple (CoC) has a potential to improve the longevity of hip arthroplasty. Dysplastic patients are relatively young and have high activity; therefore, the longevity of the implant is essential for them. Because of the anatomical property, adjusting the alignment of an uncemented implant may be sometimes difficult for them. We retrospectively evaluated 458 dysplastic hips with the primary uncemented third-generation alumina CoC followed up for 5-11 years. All cups were Spongiosa Metal II. Spongiosa Metal II stems were used for 325 hips, and SL Plus stems were used for 133 hips. The average cup angle was 39.9 degrees in inclination and 28.2 degrees in anteversion. The hip score was improved in all but 5 patients at the final follow-up. Two patients required revision surgery owing to the liner fracture caused by the metal shell damage during the initial surgery. At the final follow-up, all cups and stems were stable. The radiolucent line was observed in 4 acetabuli (2.4%) and in 43 femurs (9.4%). There was no osteolysis. No dislocation occurred in these alignments. The careful surgical technique enabled to adapt the uncemented CoC even for dysplastic hips. Uncemented Ceramic-on-Ceramic Bearing Couple for Dysplastic Osteoarthritis: A 5- to 11-Year Follow-up StudyAtsushi Kusaba, Hiroshi Sunami, Saiji Kondo, Yoshikatsu Kuroki10.1053/j.sart.2011.09.005Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6240247http://www.semarthroplasty.com/article/PIIS1045452711001246/abstract?rss=yes Young patients have been reported to have a higher risk of revision following total hip arthroplasty than older cohorts. This was attributed to the higher activity level which led to increased wear, osteolysis, and component fracture. We prospectively assessed the clinical results, wear and osteolysis, the incidence of squeaking, and the survivorship of ceramic on ceramic THA in patients younger than 50 years (mean age of 42 [18-50] years). The series included 350 THAs in 305 patients which were followed up for a mean of 7.0 years (2-14 years). At follow-up, the mean Merle d'Aubigné score improved significantly from 11.2 ±1.6 (6-15) to 17.4 ±1.0 (13-18). No osteolysis was observed in any uncemented construct. There was osteolysis around one loose cemented femoral component. There were 6 hips (1.7%) with implant-related and 4 hips (1.1%) with non-implant related reoperations resulting in a survivorship of 97.2% (95% confidence interval 95.4-99.0%) for reoperation of any kind at 14-year follow-up. The survivorship for reoperation for implant revision was 98.1% (CI, 96.5-99.6%). There was only one acetabular liner fracture (0.3%) and one femoral head fracture (0.3%) which occurred after a severe accident. There were no hip dislocations. Five patients (1.4%) noted rare or occasional squeaking. None had reproducible squeaking. In summary, the current study shows that ceramic-on-ceramic THAs in the young patient population have a very low revision rate with absence of wear-induced osteolysis. In addition, it shows that both bearing fracture and squeaking issues that have been raised relative to ceramic bearings, occur very rarely. Absence of Osteolysis in Uncemented Alumina Ceramic-on-Ceramic THA in Patients Younger Than 50 Years After Two to 14 YearsSimon D. Steppacher, Timo M. Ecker, Moritz Tannast, Stephen B. Murphy10.1053/j.sart.2011.10.005Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6248253http://www.semarthroplasty.com/article/PIIS1045452711001155/abstract?rss=yes The use of alumina ceramic bearings in total hip replacement is not new; extensive clinical outcomes have been reported since at least the past 3 decades. During that time, material advances have changed the basic composition and properties of alumina, such that femoral heads and acetabular inserts made of this material today are vastly superior in reliability, consistency, and durability than counterparts made previously. The question addressed by this article pertains to patient selection for alumina bearings during total hip surgery. To answer this question, the paper is organized to (1) present an overview of the material improvements in modern alumina bearings, (2) review the most recent clinical data related to ceramic bearing performance in total hip replacement, and (3) present practical guidelines based on literature evidence for patient selection for alumina bearings. It is hoped that this information will be of value to the hip arthroplasty surgeon. Alumina Ceramic Bearings in Total Hip Arthroplasty: The Rationale for Patient SelectionB. Sonny Bal, Mohamed N. Rahaman10.1053/j.sart.2011.09.006Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6254257http://www.semarthroplasty.com/article/PIIS1045452711001258/abstract?rss=yes Ceramics have increasingly been used since the 1970s in total joint arthroplasty, providing constant improvements in material properties. Nowadays, different ceramics (alumina, zirconia, and new composite materials) are available as bearing surfaces. Ceramic materials offer reduced wear rates at articulating surfaces because of their excellent friction properties, which support longevity of endoprosthetic implants. In total hip arthroplasty, long-term clinical studies confirm the advantageous properties of ceramic materials providing low risk of implant failure. In total knee arthroplasty, ceramics revealed superior experimental data concerning low wear rates as well as promising results of the first clinical applications. Tribological Aspects of Ceramics in Total Hip and Knee ArthroplastyCarmen Zietz, Daniel Kluess, Philipp Bergschmidt, Maximilian Haenle, Wolfram Mittelmeier, Rainer Bader10.1053/j.sart.2011.10.006Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6258263http://www.semarthroplasty.com/article/PIIS1045452711001209/abstract?rss=yes Total knee arthroplasty (TKA) has been developed into a safe and reliable procedure in orthopedic surgery. Nevertheless, in some cases, wear particles trigger the well-known cascade of osteolysis-inducing aseptic implant loosening. Furthermore, hypersensitivity to allergens such as chromium, cobalt, and nickel can lead to implant failure. These facts have led to a rising interest in research for solutions of alternative implant materials in TKA. The use of ceramics in total hip arthroplasty is based on excellent wear resistance and corrosion durability. These advantages have led to the development of a TKA system with a Biolox delta composite ceramic femoral component. In the present article, the clinical experience and radiological results of a 2-year follow-up in some standard and specific indications are presented. Furthermore, special features on intraoperative handling, advantages, as well as limitations in clinical application are demonstrated. Composite Ceramics in Total Knee Arthroplasty: Two-Year Experience in Clinical ApplicationPhilipp Bergschmidt, Daniel Kluess, Carmen Zietz, Susanne Finze, Rainer Bader, Wolfram Mittelmeier10.1053/j.sart.2011.10.001Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6264270http://www.semarthroplasty.com/article/PIIS1045452711001234/abstract?rss=yes As we enter the 4th decade of use, ceramic-on-ceramic total hip arthroplasty remains a viable bearing surface for young and active patients requiring hip replacement. Improvements in manufacturing and component design have continually improved reliability and safety of these implants. Furthermore, the latest iteration of ceramics, which allows for larger head diameters and more head and liner combinations, has further leveled the playing field when it comes to hard-on-hard bearing surfaces. Finally, with recent reports of early failures and unexplained idiosyncratic reactions in patients with metal-on-metal arthroplasty, we suggest that surgeons faced with young and active patients should consider ceramics, with its excellent wear characteristics and biocompatibility, as the only safe hard-on-hard bearing surface suitable for implantation. Reliability of Ceramic ComponentsGwo-Chin Lee, Jonathan P. Garino10.1053/j.sart.2011.10.004Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6271275http://www.semarthroplasty.com/article/PIIS1045452711001167/abstract?rss=yes Squeaking in ceramic-on-ceramic total hip replacements is a well-documented phenomenon. It is usually a benign complication, well tolerated by patients. Only rarely, it is a cause for revision surgery. The etiology of squeaking is less well understood, but clearly it has a multifactorial origin. We investigated demographic and implant position factors associated with squeaking hips, and following a series of studies on the mechanisms of noise production in this group of implants, we propose a mechanism by which the sound is generated. A Review of Squeaking in Total Hip ArthroplastyNadia Sciberras, Shaun A. Sexton, William L. Walter10.1053/j.sart.2011.09.007Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6276279http://www.semarthroplasty.com/article/PIIS1045452711001210/abstract?rss=yes In vitro studies were conducted to investigate the incidence of squeaking in total hip replacements, examining ceramic-on-ceramic, ceramic-on-metal, and metal-on-metal bearings. Third-body debris materials were introduced into each bearing, and the incidence of squeaking was noted through simple friction studies. The addition of ceramic fragments caused squeaking in all bearings, although most significantly in the metal-on-metal bearings. The incidence of squeaking correlated well with elevated friction. It is proposed that squeaking in total hip replacement is related to adverse tribological conditions, where the lubrication of the implant is compromised. Assessment of Squeaking in Total Hip ReplacementsClaire L. Brockett, Sophie Williams, Zhongmin Jin, Graham H. Isaac, John Fisher10.1053/j.sart.2011.10.002Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6280283http://www.semarthroplasty.com/article/PIIS1045452711001179/abstract?rss=yes In the case of a ceramic fracture or cup revision with exchange of the ceramic ball head on a used stem, there is always the danger of another ceramic fracture when using a standard ceramic ball head owing to a possibly damaged stem taper. The purpose of this study was to analyze the results of revision hip arthroplasty using a new ceramic revision ball head. Ninety-one patients, who underwent revision hip arthroplasty using a ceramic revision ball head, were analyzed clinically. The Harris hip score and visual analog scale score increased significantly. There were no further ceramic fractures or noises. Especially, in cases with a damaged taper or ceramic fracture, surgeons should consider using a ceramic revision ball head in combination with a ceramic or a polyethylene insert. Early Results of Revision Hip Arthroplasty Using a Ceramic Revision Ball HeadFritz Thorey, Manoon Sakdinakiattikoon, Satit Thiengwittayaporn, Henning Windhagen10.1053/j.sart.2011.09.008Seminars in Arthroplasty 22, 4 (2011)2011-12-01Seminars in Arthroplasty2011-12-01224S1045-4527(11)X0005-6284289