Ceramic-on-ceramic vs metal-on-crosslink polyethylene in a fully hydroxyapatite-coated total hip arthroplasty: Survivorship, complications and long-term results

Q2 Medicine Journal of Clinical Orthopaedics and Trauma Pub Date : 2024-10-01 DOI:10.1016/j.jcot.2024.102555

José Cordero-Ampuero , Paula Velasco , Jorge Payo-Rodríguez , Pablo Peñalver-Andrada , Enrique González-Fernández

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Abstract

Background

Few studies compare complications and results in ceramic-ceramic (CeCe) vs metal-on-crosslink polyethylene (Me-XLPE) hip prosthesis.

Methods

Prospective, non-randomized, observational analysis of 2 series of hydroxyapatite-coated Furlong Active implanted with identical protocol by 1 surgeon in 1 hospital from 2006 to 2014.

Bearing surface

CeCe (Biolox Forte/Delta) in 35 cases of 53.7 ± 10.6 years (25–69) (21 males, 60 %), Me-XLPE in 65 of 69.0 ± 8.9 years (42–81) (36 males, 55 %); age was different (p < 0.00001), but not sex (p = 0.6565). Head diameter: 28 mm in 19, 32 mm in 9 and 36 mm in 7 CeCe hips; 28 mm in 63, 32 mm in 1 and 36 mm in 1 Me-XLPe hips.

Follow-up

10.5 ± 3.1 years (1–15) in ceramic, 9.8 ± 3.8 years (2–15) in Me-XLPE.

Results

Survivorship without additional surgery or closed reduction at 15 years: 91.0 % in ceramic, 83.8 % in Me-XLPE joints. Survivorship without component exchange at 15 years: 93.9 % in ceramic, 93.6 % in Me-XLPE joints.

Complications

CeCe joints suffered 2 infections, 1 isolated dislocation, and 1 Vancouver-C fracture. Me-XLPE joints presented 2 infections (p = 0.6101), 5 isolated (p = 0.6621) and 2 recurrent dislocations (p = 0.5454), and 4 Vancouver-B fractures (p = 0.6548).

At final follow-up, Harris Hip Score averaged 93.2 ± 13.7 (23–100) in ceramic and 94.3 ± 8.7 (65–100) in XLPE joints (p = 0.64552).

Measured radiographic wear reached 0.06 ± 0.38 mm (0–1.5) (0.0057 mm/year) in CeCe and 0.16 ± 0.5 mm (0–2) (0.0163 mm/year) in Me-XLPE (p = 0.30302). At final radiographic follow-up, osteolysis was present in 8 Charnley-De Lee zones (6 patients) (17 %) of ceramic cups and in 25 zones (15 patients) (23 %) of XLPE cups (p = 0.980127).

Conclusion

At 10 years follow-up, metal-XLPE and ceramic-ceramic joints in Furlong-H-A.C. Active present no significant differences in complications, clinical score, wear, acetabular osteolysis, or survivorship without component exchange.

Nevertheless, survivorship without any surgery or closed reduction is different because of the high rate of dislocation in 28 mm metal-poly joints.

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全羟基磷灰石涂层全髋关节置换术中的陶瓷对陶瓷与金属对交联聚乙烯：存活率、并发症和长期效果

背景很少有研究对陶瓷（CeCe）与交联聚乙烯（Me-XLPE）髋关节假体的并发症和效果进行比较。方法对2006年至2014年期间一家医院的一名外科医生以相同方案植入的2个系列羟基磷灰石涂层Furlong Active进行前瞻性、非随机、观察性分析。35例（53.7±10.6岁，25-69岁）患者的轴承表面为CeCe（Biolox Forte/Delta）（21名男性，60%），65例（69.0±8.9岁，42-81岁）患者的轴承表面为Me-XLPE（36名男性，55%）；年龄有差异（p <0.00001），但性别无差异（p = 0.6565）。头部直径：19 个 CeCe 髋关节为 28 毫米，9 个为 32 毫米，7 个为 36 毫米；63 个 Me-XLPe 髋关节为 28 毫米，1 个为 32 毫米，1 个为 36 毫米。随访陶瓷髋关节 10.5 ± 3.1 年（1-15），Me-XLPE 髋关节 9.8 ± 3.8 年（2-15）：陶瓷关节的存活率为91.0%，Me-XLPE关节的存活率为83.8%。15年后无需更换组件的存活率：陶瓷关节为93.9%，Me-XLPE关节为83.8%：并发症CeCe关节有2处感染、1处孤立脱位和1处Vancouver-C骨折。最后随访时，Harris髋关节评分平均为 93.2 ± 13.7（23-100）。在最终随访中，陶瓷关节的 Harris 髋关节评分平均为 93.2 ± 13.7 (23-100)，XLPE 关节的评分平均为 94.3 ± 8.7 (65-100)（p = 0.64552）。CeCe 关节的放射磨损测量值为 0.06 ± 0.38 mm (0-1.5) (0.0057 mm/年)，Me-XLPE 关节的放射磨损测量值为 0.16 ± 0.5 mm (0-2) (0.0163 mm/年)（p = 0.30302）。在最终的放射学随访中，陶瓷杯有 8 个 Charnley-De Lee 区（6 名患者）（17%）出现骨溶解，XLPE 杯有 25 个区（15 名患者）（23%）出现骨溶解（p = 0.980127）。然而，由于 28 毫米金属-聚合关节的脱位率较高，因此在不进行任何手术或闭合复位的情况下，其存活率也有所不同。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.