Failure of a Novel Ceramic-on-Ceramic Hip Resurfacing Prosthesis

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Abstract

We report the early failure of five ceramic-on-ceramic hip resurfacings (CoCHRs). The ceramic used for the acetabular liner was a novel ceramic-composite (two thirds polyurethane and one third alumina ceramic). All cases were revised for increasing metal ion levels (blood cobalt 3.93–208.0 μg/l and chromium 1.57–17.5 μg/l) due to ceramic liner fracture and/or accelerated wear of the ceramic femoral head coating. Patients underwent bearing exchange and revision using primary hip arthroplasty implants at a mean of 3.0 years following CoCHR. Intraoperatively all patients had metallosis. At 1 to 2 years of follow-up blood metal ions normalized with no complications. We do not recommend this particular type of ceramic-on-ceramic bearing for hip resurfacing.

Section snippets

Patients and Methods

Between 2008 and 2009 a CoCHR device (ESKA, Lübeck, Germany) was implanted in five patients (five hips) for primary osteoarthritis after detailed discussion with the patient and informed consent. All patients were suitable for HR but had a history of intolerance to metals and tested positive for nickel hypersensitivity on lymphocyte transformation testing. Each patient had normal renal function, with no other metal implants or hardware in the body. The CoCHR device consisted of a cemented

Results

All five patients had an uneventful recovery and excellent early results. The mean acetabular component inclination and anteversion was 39.8° (range 34°–47°) and 14.2° (range 10°–18°) respectively. After up to 3 years of symptom-free hip function all patients developed symptoms (including clicking, discomfort, and pain) and progressively increasing systemic metal ion concentrations requiring revision surgery at a mean of 3.0 years (Table 1). All patients had highly elevated metal ion levels in

Discussion

This represents the first case series in the literature of the outcomes of a modern CoCHR device. CoCHR was used in patients who were suitable for HR but had hypersensitivity to nickel, in order to avoid the risk of ARMD. After an initial symptom-free and low metal ion release period, all patients developed symptoms and significantly raised blood and urine metal ion concentrations requiring revision. This was due to the development of an unintended metal-on-ceramic or metal-on-metal

Acknowledgments

All the work presented here was carried out by the four listed authors, and therefore there are no additional acknowledgments to be declared.

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No grants or funding have directly been received by any of the authors for the work presented.

The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.10.019.

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