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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


  1. Ceramic-on-Ceramic THA John M. Keggi, MD Connecticut Joint Replacement Institute

  2. 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

  3. Levy and Walter, Springer 2017

  4. • 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

  5. • 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

  6. Levy and Walter, Springer 2017

  7. • 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”

  8. • 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

  9. • 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”

  10. • 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”

  11. • Equal functional & radiographic outcomes

  12. • 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

  13. • 50 hip CoP • 9 fluid collections • 5 synovitis • 4 synovial thickening

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

  15. What Could Possibly Go Wrong? • Modular necks • Double the corrosion • Big Metal Heads • >2x the liability • Highly VL Poly • Half the fracture resistance • Twice the wear • Dual Mobility

  16. • “Although damage was not severe enough to lead to intraprosthetic dislocation, failure may occur long term…”

  17. 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.

  18. Thank You

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