Ceramic hip joints durable option for hip-fracture patients
MedWire News: Total hip replacement with an alumina-on-alumina ceramic coupling protects the hip from dislocation and offers minimal friction and wear even with large femoral heads, Italian researchers report.
Guiseppe Solarino (Policlinico Universitario, Bari) and colleagues explain that total hip replacement is considered the best treatment option for displaced intracapsular fractures of the femoral neck, which often occur as a direct result of osteoporosis.
Dislocation of the implant is a complication of this surgery, and is more common with smaller (28 mm) femoral heads. Larger heads (32 mm), however, can cause more wear, osteolysis, and ultimately failure of the implant, particularly when coupled to a polyethylene inlay.
The researchers explain that ceramic implants induce less friction and minimize wear, even with larger heads.
In the present study, the team evaluated the outcomes of 35 primary total hip replacements carried out for displaced intracapsular femoral neck fractures, using a 32mm alumina-alumina ceramic coupling.
During a mean follow-up period of 80 months, none of the implants needed revision for any reason, none of the cups failed, and all were well fixed, without migration or tilting. The team did not find any dislocations or breakages of the ceramic components, and only one anatomic cementless stem observed to be loose on radiological imaging
In addition, one patient reported a transient squeaking sensation - a known problem associated with ceramic-on-ceramic implants - possibly caused by a short neck length in the femoral implant.
Solarino and co-authors note that the lack of a control group is a weakness of the study but say their findings show that the use of alumina-on-alumina implants for total hip replacement yields satisfactory results in the medium term in young patients (median age 66 years) with no co-morbidities who were in good mental health and at the lower end of the age range for the procedure (meadian age 66 years).
"We are aware that the greater cost of ceramic-on-ceramic than ceramic-polyethylene coupling is a problem," the researchers add. "Nevertheless, if clinical studies of larger cohorts demonstrate a better survival, they will justify this surgical choice."
The results of this study are published in the journal BMC Musculoskeletal Disorders.
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By Laura Dean