Mid-term results of the BIOLOX®delta ceramic-on-ceramic total hip arthroplasty
- Lee, Y. K., Y. C. Ha, J. I. Yoo, W. L. Jo, K. C. Kim and K. H. Koo
- Bone Joint J 2017; 99-b(6): 741-748.
- Level of Evidence
- None given. Prospective study.
Lee et al. conducted a prospective study to evaluate the mid-term results of a specific THA system (DePuy; Corail, Pinnacle) with BIOLOX®delta CoC bearings. Only patients with at least 5 years of follow-up were included in the analysis.
The cohort consisted of 252 patients (286 THA) with a mean age of 49.7 years. Primary diagnosis was mostly osteonecrosis. A 32 mm bearing was used in 247 hips (86 %) and 36mm in 39 hips (14 %). The mean follow-up was 5.5 years.
Clinical outcome scores (HHS, WOMAC, UCLA activity) improved significantly post-op. Only 21 patients reported thigh pain, however, without limitations to their activity level or requiring medication. Radiological assessment showed evidence of bone ingrowth for all THA components, no measurable wear and no evidence of osteolysis. Kaplan-Meier survival rate, with revision for any reason as endpoint, was 99.4 % at 6 years. Three patients needed revision surgery; one for periprosthetic fracture, one for infection, and one for fracture of a malseated (tilted) ceramic liner which was revised with a new ceramic head and a highly crosslinked PE liner. There was no fracture of a ceramic ball head during the study period. 34 patients reported noise from their hip implant: grinding (20 hips), non-reproducible squeaking (7), snapping (3), clicking (2), cracking and popping (1 each). Neither pain nor functional limitations were associated with noise.
According to the authors’ conclusions, the mid-term survivorship of 4th generation ceramic-on-ceramic bearing surfaces is encouraging. However, insert malseating might be a concern.
- Study without control group
- The main primary diagnosis for THA in Korea is osteonecrosis which is not common in western countries.
- Only one THA system used
- Mid-term follow up
- The CoC solution with BIOLOX®delta shows encouraging mid-term outcome in highly active and young patients diagnosed with osteonecrosis, normally showing lower survival rates than in patients with osteoarthritis.
- There was no ceramic head fracture and one liner fracture due to malseating.
- Ceramic-liner malseating is a frequent cause of ceramic-liner fracture.
- 11.9 % of patients reported noise generated from their THA
- 2.5 % of patients reported non-reproducible squeaking