Choosing a Femoral Head: A Survey Study of Academic Adult Reconstructive Surgeons
- S. Nandi, M.S. Austin; University of Toledo, Ohio & Rothman Institute, Philadelphia, USA
- The Journal of Arthroplasty 2017; in press, http://dx.doi.org/10.1016/j.arth.2016.12.009. Online Dec 2016
- Level of Evidence
- Not applicable.
Nandi and Austin investigated the attitude of academic orthopaedic surgeons towards the use of ceramic and CoCr femoral heads for THA using a simple 16-question survey which they sent to 274 faculties at 42 US adult reconstruction fellowship programs.
The response rate was 42.2%. The responding surgeons use ceramic heads 72.9% of the time and 47% use ceramic heads for all their patients. 38% use ceramic heads dependent on age, and 12% dependent on activity level. 3% of respondents do not use ceramic heads at all. If a CoCr head is chosen, costs (45%), limitations in neck length options (33%) and concern with potential ceramic fracture (11%) are the main reasons. 4% of the academic surgeons think that there is no benefit in using ceramic heads. Cost difference between ceramic and CoCr heads varies between none (22%) and up to $1’000 (9%), 18% of surgeons did not know the cost difference. If it is below $300 surgeons would preferably use ceramics heads.
Surgeons have personally observed corrosion at the head-neck tapers with CoCr or ceramic heads on polyethylene in 94% and 9.5%, respectively. For revision THA due to corrosion 96% would use a ceramic femoral head and in case the stem is left in situ 91% would use a ceramic head with a titanium sleeve. 81% expect the possibility of corrosion at any time if a CoCr head is used on any stem taper and 72.4% are concerned about it. Nevertheless, only 46% of the respondents think that a ceramic head should be the standard of care.
There is still a concern for ceramic fracture (16%) and 6% of the responding surgeons have already seen a fracture of a BIOLOX®delta ceramic head. The long-term wear of CoCr and ceramic heads on cross-linked PE was not thought to be different (53% yes, 46% no).
The authors conclude that the respondent surgeons are guided by evidence which indicates that taper corrosion and fracture is rare with ceramic heads. However, implant selection is strongly influenced by cost and personal experience.
- Survey in USA only.
- Response rate only 42%.
- Not clear if survey responses are an accurate reflection of actual surgeons practice.
- Similar questions received different answers.
- Choices for survey answers may not have addressed all possible practices.
- Answers were not collected anonymously.
- Almost half of the responding surgeons survey use ceramic heads and think that ceramic femoral heads should be standard of care.
- The most common reason for not using ceramic heads in all patients was costs followed by limited neck length options.
- Most surgeons were concerned about taper corrosion and have actually seen it.
- Concerns about ceramic fracture still exist.
- About half the respondents think that long-term wear performance is not significantly different between ceramic and CoCr heads on cross-linked PE.