Insights on Bearing Surfaces for Total Hip Arthroplasty

    Four joint replacement specialists share their thoughts on the use of ceramic-on-ceramic, ceramic-on-polyethelene, metal-on-polyethylene, metal-on-metal implants for THA patients.

    Delta Ceramic-on-Ceramic THA – Midterm Investigational Device Exemption (IDE) Study Results
    Douglas A. Dennis, MD
    Colorado Joint Replacement, Denver, Colorado

    Dr. Douglas Dennis shares the mid-term results of an 8-center FDA Investigational Device Exemption study of a ceramic-on-ceramic implant in 345 hips, with a mean follow-up of 5.3 years.

    He notes the many benefits of this type of bearing surface, including:

    • Low wear rate
    • Low rate of osteolysis
    • Hardness of the bearing, which makes it resistant to third-body wear
    • Longevity of the implant in younger patients

    In addition, larger head sizes are available, which allows the patient greater range of motion and improved stability.

    The presentation by Dr. Dennis is from the World Arthroplasty Congress in Paris. Click image below to watch the presentation.

    Ceramic-PE: The New Gold Standard?
    Luigi Zagra, MD, PhD
    Istituto Ortopedico Galeazzi IRCCS, Milan, Italy

    Wear and consequent osteolysis are major causes of late failure in total hip arthroplasty, said Dr. Luigi Zagra, making proper bearing surface selection essential for implant survivorship and preservations of bone stock.

    Since 2004, he has used ceramic-on-cross-linked polyethylene bearings for his patients over age 60, and 1700 cases later, none of his patient has experienced breakage of the liner or shown evidence of major osteolysis.

    Compared with metal-on-polyethylene, ceramic-on-polyethylene bearings have better biocompatibility and mitigate the fretting and corrosion associated with metal bearings, Dr. Zagra said.

    The presentation by Dr. Zagra is from the Transatlantic Orthopaedic Congress in New York. Click image below to watch the presentation.

    My Decision Making Regarding Bearing Surfaces
    Thomas K. Donaldson, MD
    Empire Orthopedic Center, Colton, California

    Because dislocation is still an issue in total hip arthroplasty, surgeons have adopted the use of larger femoral heads to provide patients with greater impingement-free range of motion.

    But what material should be used in these bearing surfaces?

    Dr. Thomas Donaldson reviews what’s known about metal-on-metal, ceramic-on-ceramic, and metal- or ceramic-on-highly cross-linked polyethylene and shares his preference.

    Metal-on-metal is largely historical at this point, he says, except for some resurfacing procedures in male patients. Although he mentions squeaking and fracture as potential problems with ceramic-on-ceramic bearings, he says they are a good option for male and female patients under age 50 because of the long-term survivorship of the implant.

    For his patients, he prefers metal- or ceramic-on-polyethylene bearings because registry data show these implants are reliable and can give a good 20- to 30-year outcome.

    The presentation by Dr. Donaldson is from the Transatlantic Orthopaedic Congress in New York. Click image below to watch the presentation.

    Tips for Revising Failed Metal-on-Metal THAs
    Matthew S. Austin, MD
    The Rothman Institute, Philadelphia, Pennsylvania

    In addressing revision for failure of metal-on-metal implants, Dr. Matt Austin says that the same principles apply to other troubling situations, including trunion corrosion and issues with modular components.

    His tips for managing patients with failed metal-on-metal implants include:

    • Extensive preoperative planning to know which components will be exchanged and which will be retained and how bone and soft tissue loss will be managed
    • Communicating the surgical plan (and any back-up plans) to the entire team
    • Simplifying the surgical setup so that only the acetabular and femoral instruments that are truly needed are available
    • Ensuring adequate exposure to see and remove the components
    • Counseling patients that the jury is still out on the results of revision procedures in these cases

    The presentation by Dr. Austin is from ICJR’S annual Winter Hip & Knee Course in Vail, Colorado. Click image below to watch the presentation.