Ceramic-on-Ceramic THA John M. Keggi, MD Connecticut Joint - - PowerPoint PPT Presentation

Ceramic-on-Ceramic THA

John M. Keggi, MD

Connecticut Joint Replacement Institute

Disclosures

• Smith & Nephew - Consultant
• OmniLife Science - Consultant &

Royalties

• Medtronic - Consultant
• Concept Design and Development
• Corin - Institutional support
• JISRF - Institutional support

No conflicts relevant to the content of this presentation

Levy and Walter, Springer 2017

• 5.98 Million ceramic heads

– Pure alumina (PA) & Alumina Matrix Composite (AMC)

• PA 1:5000 (0.0201%)
• AMC 1:100,000 (0.0010%)
• Smaller heads & shorter lengths

• IDE
• 96.9% survivorship at 6 years
• 2/345 Revised for liner fx
• Squeaking reported 7.5%
• Only 1 pt (0.3%) could demonstrate

squeaking in clinic

Levy and Walter, Springer 2017

• 99.3% survivorship
• 1 case of squeaking with 62 degree cup
• 1 canted liner ==> liner fx
• 2 loose cups <== screw impingement
• 1 head fx <== 60 degree cup
• “technical errors that surgeons should avoid”

• 1131 hips
• 15-20 yr f/u (18.8 yr average)
• 99.7% survivorship
• 4 squeakers
• 0.9% instability
• No revisions for aseptic loosening of fracture
• No osteolysis

• Phase transformation time dependent
• Transformation NOT related to roughness
• Presence of metal transfer

– Still very low roughness

• “use of an alumina-zirconia composite ceramic is a

viable option for femoral heads”

• Phase transformation time dependent
• Transformation NOT related to roughness
• Presence of metal transfer

– Still very low roughness

• “use of an alumina-zirconia composite ceramic is a

viable option for femoral heads”

• Equal functional

& radiographic

• utcomes

• Equal functional outcomes at 10 years
• No difference in bearing complications

– None in either group

• 3/44 poly patients revised for instability (6.8%)

– 0 CoC revisions

• 50 hip CoP
• 9 fluid collections
• 5 synovitis
• 4 synovial thickening

• Good outcomes
• 0% instability with dual mobility
• 5.1% instability with fixed bearing

What Could Possibly Go Wrong?

• Modular necks
• Big Metal Heads
• Highly VL Poly
• Dual Mobility
• Double the corrosion
• >2x the liability
• Half the fracture

resistance

• Twice the wear

• “Although damage was not severe enough

to lead to intraprosthetic dislocation, failure may occur long term…”

The Last Word on CoC

• Our data on the low incidence of implant

noise and the negligible effect of squeaking on patient quality of life following ceramic-on-ceramic total hip arthroplasty supports the continued use of this implant system. Improvements in Harris Hip Score as well as the low rates of early revision and instability further confirm the safety and efficacy of this procedure in the younger patient in whom longer term use is a concern.

Thank You