Component positioning and ceramic damage in cementless ceramic-on-ceramic total hip arthroplasty

Francesco Castagnini, Giordano Valente, Gianluigi Crimi, Fulvia Taddei, Barbara Bordini, Susanna Stea, Aldo Toni

Research output: Contribution to journalArticle

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Abstract

Background: In ceramic-on-ceramic (CoC) total hip arthroplasty (THA), component positioning demonstrated to influence the bearing damage: however the connection between angles and clinical outcomes at long-term follow-ups is currently lacking. Aims of this study were: the computer tomography (CT) assessment of component positioning in CoC THAs; the correlation analysis between positioning and ceramic damage; the identification of safe zones. Methods: 91 consecutive post-operative CT scans including two types of CoC implants, with a mean follow-up of 12 ± 4.4 years, were evaluated. III generation (74.2%) and IV generation (25.8%) CoC surfaces were included. The angle measurements (cup abduction, anteversion, cup tilt, stem antetorsion, sacral slope) were automated using a CT-based software. The combined anteversion was assessed as well as the cup-neck position at −15° 0° 45° and 90° of flexion. Ceramic damage was diagnosed using synovial fluid analyses and radiological criteria. Results: 63.7% of THAs was inside the cup abduction target 30°–45° and 68.1% was inside the cup anteversion target 5°–25°. 19 patients (20.9%) showed signs of ceramic damage. High cup abduction and high cup-neck 45° minimum angle (which stood for high abduction and extreme combined version) significantly correlated with ceramic damage. No demographical features apart III generation ceramic bearings influenced the results. No safe zones could be detected. Conclusions: In CoC THA, no safe zones can be described. However it is important to avoid cup inclination over 45° and a combination of steep cup and extreme combined version.

Original languageEnglish
JournalJournal of Orthopaedic Science
DOIs
Publication statusE-pub ahead of print - Jan 3 2019

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Ceramics
Arthroplasty
Hip
Tacrine
Tomography
Neck
Synovial Fluid

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Component positioning and ceramic damage in cementless ceramic-on-ceramic total hip arthroplasty. / Castagnini, Francesco; Valente, Giordano; Crimi, Gianluigi; Taddei, Fulvia; Bordini, Barbara; Stea, Susanna; Toni, Aldo.

In: Journal of Orthopaedic Science, 03.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: In ceramic-on-ceramic (CoC) total hip arthroplasty (THA), component positioning demonstrated to influence the bearing damage: however the connection between angles and clinical outcomes at long-term follow-ups is currently lacking. Aims of this study were: the computer tomography (CT) assessment of component positioning in CoC THAs; the correlation analysis between positioning and ceramic damage; the identification of safe zones. Methods: 91 consecutive post-operative CT scans including two types of CoC implants, with a mean follow-up of 12 ± 4.4 years, were evaluated. III generation (74.2{\%}) and IV generation (25.8{\%}) CoC surfaces were included. The angle measurements (cup abduction, anteversion, cup tilt, stem antetorsion, sacral slope) were automated using a CT-based software. The combined anteversion was assessed as well as the cup-neck position at −15° 0° 45° and 90° of flexion. Ceramic damage was diagnosed using synovial fluid analyses and radiological criteria. Results: 63.7{\%} of THAs was inside the cup abduction target 30°–45° and 68.1{\%} was inside the cup anteversion target 5°–25°. 19 patients (20.9{\%}) showed signs of ceramic damage. High cup abduction and high cup-neck 45° minimum angle (which stood for high abduction and extreme combined version) significantly correlated with ceramic damage. No demographical features apart III generation ceramic bearings influenced the results. No safe zones could be detected. Conclusions: In CoC THA, no safe zones can be described. However it is important to avoid cup inclination over 45° and a combination of steep cup and extreme combined version.",
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AU - Castagnini, Francesco

AU - Valente, Giordano

AU - Crimi, Gianluigi

AU - Taddei, Fulvia

AU - Bordini, Barbara

AU - Stea, Susanna

AU - Toni, Aldo

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N2 - Background: In ceramic-on-ceramic (CoC) total hip arthroplasty (THA), component positioning demonstrated to influence the bearing damage: however the connection between angles and clinical outcomes at long-term follow-ups is currently lacking. Aims of this study were: the computer tomography (CT) assessment of component positioning in CoC THAs; the correlation analysis between positioning and ceramic damage; the identification of safe zones. Methods: 91 consecutive post-operative CT scans including two types of CoC implants, with a mean follow-up of 12 ± 4.4 years, were evaluated. III generation (74.2%) and IV generation (25.8%) CoC surfaces were included. The angle measurements (cup abduction, anteversion, cup tilt, stem antetorsion, sacral slope) were automated using a CT-based software. The combined anteversion was assessed as well as the cup-neck position at −15° 0° 45° and 90° of flexion. Ceramic damage was diagnosed using synovial fluid analyses and radiological criteria. Results: 63.7% of THAs was inside the cup abduction target 30°–45° and 68.1% was inside the cup anteversion target 5°–25°. 19 patients (20.9%) showed signs of ceramic damage. High cup abduction and high cup-neck 45° minimum angle (which stood for high abduction and extreme combined version) significantly correlated with ceramic damage. No demographical features apart III generation ceramic bearings influenced the results. No safe zones could be detected. Conclusions: In CoC THA, no safe zones can be described. However it is important to avoid cup inclination over 45° and a combination of steep cup and extreme combined version.

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