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      Evolution of Alumina-on-Alumina Implants : A Review

      Clinical Orthopaedics and Related Research
      Ovid Technologies (Wolters Kluwer Health)

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          The use of dense alumina-alumina ceramic combination in total hip replacement.

          The purpose of this article was to review the laboratory and clinical performances since 1970 of a total hip prosthesis using alumina-alumina combination. The chemical and physical properties of dense alumina ceramic were studied in relation to biocompatibility, mechanical strength, and surface properties. Through the examination of 35 retrieved implants, it was found that the long-term success of alumina-alumina total hip replacement depends on both the ceramic microstructure (small grain size with uniform distribution, minimum porosity, absence of inclusions) and implant geometry (sphericity deviation +/- 1 micron, radius tolerance between components 7-10 microns). Alumina component wear and fractures have disappeared with the use of high-performance materials and severe manufacturing quality control. Examination of human biopsies from well-fixed prostheses showed that alumina particles deposits increase with time with only a low-grade macrophagic reaction. When loosening occurred, an inflammatory reaction appeared; this reaction was less striking than with loose metal-polyethylene prostheses, however. The long-term behavior of cementless alumina cup fixation depends upon initial positioning and stability; survivorship analysis of the cemented ceramic cups showed an 88% survival probability after 8 years with a 1.6% average annual probability of revision. The percentage of surviving was 100% after 8 years in patients who were less than 50 years old. Aseptic loosenings occurring at the cup-cement interface were assumed to be related to stress protection secondary to the high rigidity of the ceramic leading to a weakening of the spongious bone supporting the cement mantle. Good bone stock quality as well as high-quality ceramic appear to be the prerequisites for durable fixation of alumina sockets.
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            Friction and wear properties of polymer, metal, and ceramic prosthetic joint materials evaluated on a multichannel screening device.

            A 12-channel wear screening device was used to compare the wear properties of a variety of prosthetic joint materials. Two types of tests were run: (1) Ultrahigh molecular weight (UHMW) polyethylene bearing against metal or ceramic counterfaces and (2) various polymers bearing against 316 stainless steel as a standard counterface. Wear was quantified by weighing the polymer specimens, with presoaking and control-soak specimens used to minimize the error due to fluid absorption. The specimens were lubricated with bovine blood serum. Friction and polyethylene wear was very low with each of the metals (316 stainless steel, cobalt-chrome alloy, multiphase alloy, and titanium 6-4 alloy) such that the differences in wear rate would not be significant in terms of choosing a material for clinical application. However, titanium 6-4 alloy was found to be especially susceptible to abrasive wear by particles of acrylic cement. Nitrided titanium 6-4 counterfaces were impervious to acrylic abrasion. Polyethylene wear against highly polished, fully dense ceramics (Sialon, Alumina, Macor, and pyrolytic graphite) was as low as that with the metal counterfaces. Wear increased slightly with increasing ceramic surface roughness. The coefficient of friction of polyethylene against pyrolytic graphite was two to three times higher than with the metals or other ceramics. All of the alternate polymers underwent more wear than UHMW polyethylene. Teflon and polyester, two polymers that have proven unsuccessful in prior clinical use, had wear rates 1,600 and 830 times greater than polyethylene, respectively, an indication that the laboratory wear test provided a quantitative prediction of the behavior of the materials in vivo. However, it was difficult to assess the clinical significance of the less extreme wear rates since the ability of the tissues encapsulating a prosthesis to accomodate wear debris is not known on a quantitative basis.
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              Prosthetic component failures in hip arthroplasty surgery.

              A survey was conducted of the entire membership of the American Association of Hip and Knee Surgeons to determine their experience with total hip arthroplasty (THA) device-related failures. Forty-seven percent of the membership reviewed their preceding 5-year clinical experience and returned the survey instrument. The aggregate 5-year volume encompassed experience with more than 60,000 hip arthroplasties. The median 5-year experience per respondent was 200 metal-based sockets and 214 metal stems. The frequency distribution of the number of hip arthroplasties per respondent was skewed to the right, with fewer surgeons reporting the higher volumes of arthroplasties. In aggregate, 60,115 of the acetabular components used were metal backed. Nonmetal acetabular component usage totaled 3,219. Complete polyethylene failure was defined as fracture or complete wear through of the polyethylene portion of the component. Complete polyethylene failure was seen in 172 metal-backed sockets (29/10,000). Seventy-seven all-polyethylene sockets had complete polyethylene failure (239/10,100). A total of 87 THAs were revised for modular acetabular dissociations for a dissociation rate of 15/10,000. In aggregate, 64,483 metal-stemmed components were used. Femoral stem fractures occurred in 172 for a rate of 27/10,000. A total of 56,965 metallic femoral components were reported as being modular. Dissociation between the femoral head and neck was uncommonly seen (3/10,000). Use of ceramic femoral heads was low (5,023); however, a total of 11 ceramic head fractures were revised in the 5-year period for a failure rate of 22/10,000. The risks of catastrophic prosthetic THA failure are low but vary according to hip component and the manufacturer of the part.
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                Author and article information

                Journal
                Clinical Orthopaedics and Related Research
                Clinical Orthopaedics and Related Research
                Ovid Technologies (Wolters Kluwer Health)
                0009-921X
                2000
                October 2000
                : 379
                : 48-54
                Article
                10.1097/00003086-200010000-00008
                bd419556-e85d-4ad7-9c88-082da02f374e
                © 2000
                History

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