Comparison of Wear Rate between Ceramic-on- Ceramic, Metal on Highly Cross-linked Polyethylene, and Metal-on-Metal Bearings

Higuchi, Yoshitoshi; Seki, Taisuke; Morita, Daigo; Komatsu, Daigo; Takegami, Yasuhiko; Ishiguro, Naoki

doi:10.1055/s-0039-1691762

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Original Article • Rev. bras. ortop. 54 (03) • May-Jun 2019 • https://doi.org/10.1055/s-0039-1691762 copy

Comparison of Wear Rate between Ceramic-on- Ceramic, Metal on Highly Cross-linked Polyethylene, and Metal-on-Metal Bearings^* * The present study was conducted at the Department of Orthopedic Surgery of the Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku Nagoya, Japan.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Currently, there is a lack of evidence on the medium-term follow-up of cementless total hip arthroplasty (THA) using metal on highly cross-linked polyethylene (MoP), ceramic-on-ceramic (CoC), and metal-on-metal (MoM) bearings. Our aim was to calculate the 5- to 10-year wear rate and the incidence rate of osteolysis for 3 types of bearings.

Methods

A total of 77 patients underwent MoP, 105 underwent ceramic CoC, and 55 underwent MoM THAs. The average patient age at the time of surgery was 64.7, 55.9, and 59.9 years old in the MoP, CoC, and MoM bearings, respectively. Clinical and radiologic measurements at a mean follow-up of 7.6 years were analyzed.

Results

The mean postoperative Harris hip scores showed no difference among the groups. The mean annual liner wear rates were 0.0160, 0.0040 and 0.0054 mm/year in MoP, CoC bearings, and MoM bearings, with that of CoC bearings being significantly lower than the others. Osteolysis (14.5%) among MoM bearings was significantly more frequently observed compared with the others. Kaplan-Meier survival at 10 years with implant loosening, or revisionTHA as the endpoint, was 96.1% (95% confidence interval [CI]: 88.4-98.7) forMoP, 98.6% (95% CI: 90.3-98.6) for CoC bearing, and 98.2% (95% CI: 88.0-99.7) for MoM bearings (p = 0.360).

Conclusion

Excellent clinical and radiological outcomes were obtained for MoP and CoC bearings.

Keywords:
arthroplasty; ceramics; metals; polyethylenes; prosthesis design

Parameters	MoP(n= 77)	CoC(n= 105)	MoM(n= 55)	p-value
Age (years old) (range)	64.7 ± 9.7(29–76)	55.9 ± 8.7(28–76)	59.9 ± 10.8(33–74)	‹ 0.001^* CoC THAs vs MoM THAs p< 0.001. ^† CoC THAs vs MoP THAs p< 0.001.
Gender (male/female)	9/68	20/85	11/44	0.320
Body mass index (kg/m²) (range)	23.1 ± 3.2(15.6–31.2)	23.0 ± 3.5(16.7–31.9)	23.3 ± 3.4(18.3–35.1)	0.849
Follow up (years) (range)	7.0 ± 1.0(5–10)	7.0 ± 1.1(5–10)	7.6 ± 1.1(5–10)	0.466
Diagnosis (n, %)				0.769
Osteoarthritis	73 (94.8%)	93 (88.6%)	50 (90.9%)
Avascular necrosis	4 (5.2%)	11 (10.5%)	5 (5.1%)
Post-traumatic osteoarthritis	0	1 (0.9%)	0
Implants
Cementless Cup
Trident PSL	24 (31.2%)	22 (21.0%)	NA
TriAD HA	53 (68.8%)	74 (70.5%)	NA
Secur Fit AD	NA	9 (8.5%)	NA
Pinnacle-A	NA	NA	55 (100%)
Cementless Stem
Super Securfit HA	77 (100%)	105 (100%)	NA
G2 stem	NA	NA	55 (100%)
Fomoral head diameter
22 mm	7 (9.1%)	NA	0
26 mm	70 (91.9%)	NA	0
28 mm	0	67 (63.8)	28 (50.9%)
32 mm	0	38 (36.2)	NA
36 mm	0	0	27 (49.1%)

Parameters	MoP(n= 77)	CoC(n= 105)	MoM(n= 55)	p-value
HHS
Preoperative	57.0 ± 9.7	59.9 ± 9.2	61.2 ± 10.5	0.067
Last follow-up	87.0 ± 8.0	89.9 ± 7.3	90.3 ± 7.1	0.054
Acetabular component position
Anteversion (°)	20.7 ± 5.5	17.4 ± 6.9	19.6 ± 3.1	0.059
Inclination (°)	46.9 ± 5.5	45.9 ± 5.5	45.1 ± 3.1	0.158
Osteolysis
Overall	2 (2.6%)	2 (1.9%)	8 (14.5%)	‹ 0.001^* CoC THAs vs MoM THAs: p< 0.001. ^† MoM THAs vs MoP THAs: p< 0.05.
Acetabular	2 (2.6%)	1 (0.9%)	5 (9.1%)	0.016^‡ CoC THAs vs MoM THAs: p< 0.05.
Femoral	1 (1.3%)	2 (1.9%)	4 (7.3%)	0.143
Aseptic loosening
Overall	2 (2.6%)	0	1 (1.8%)	1
Cup	1 (1.3%)	0	1 (1.8%)	1
Stem	1 (1.3%)	0	0	1

Parameters	MoP(n= 77)	CoC(n= 105)	MoM(n= 55)	p-value
Revision THA	1 (1.3%)	1 (0.9%)	0	0.598
Deep joint infection	0	0	0	1
Dislocation	2 (2.6%)	2 (1.9%)	1 (1.8%)	0.797
DVT, PE	1 (1.3%)/0	0/0	0/0	0.556
Heterotopic bone	4 (5.2%)	2 (1.9%)	2 (3.6%)	0.138
Ceramic fracture	NA	0	NA
Audible Squeaking		1 (0.9%)

Parameters	MoP(n= 77)	CoC(n= 105)	MoM(n= 55)	p-value
Wear rate (mm/year)
AP view	0.0161 ± 0.0051	0.0041 ± 0.0022	0.0054 ± 0.0019	‹ 0.001^‡ CoC THAs vs MoM THAs: p< 0.05 (95% confidence interval [CI]: 0.00071–0.00292). ^§ CoC THAs vs MoP THAs: p< 0.001 (95% CI: 0.01115–0.00137). ^¶ MoM THAs vs MoP THAs: p< 0.001 (95% CI: 0.00934–0.01253).
Lauenstein view	0.0158 ± 0.0061	0.0043 ± 0.0026	0.0053 ± 0.0020	‹ 0.001^** CoC THAs vs MoP THAs: p< 0.001 (95% CI: 0.00997–0.01268). ^†† MoM THAs vs MoP THAs: p< 0.001 (95% CI: 0.00900–0.01221).

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[1] Address for correspondence
Yoshitoshi Higuchi, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku Nagoya, Japan 466-8550 (e-mail: rdggd215@yahoo.co.jp).

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Comparison of Wear Rate between Ceramic-on- Ceramic, Metal on Highly Cross-linked Polyethylene, and Metal-on-Metal Bearings* * The present study was conducted at the Department of Orthopedic Surgery of the Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku Nagoya, Japan.

Abstract

Objective

Methods

Results

Conclusion

Comparison of Wear Rate between Ceramic-on- Ceramic, Metal on Highly Cross-linked Polyethylene, and Metal-on-Metal Bearings^* * The present study was conducted at the Department of Orthopedic Surgery of the Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku Nagoya, Japan.