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. 2008 May;466(5):1186-92.
doi: 10.1007/s11999-008-0168-9. Epub 2008 Feb 21.

Alumina inlay failure in cemented polyethylene-backed total hip arthroplasty

Kentaro Iwakiri  1 , Hiroyoshi Iwaki, Yukihide Minoda, Hirotsugu Ohashi, Kunio Takaoka
Affiliations

Alumina inlay failure in cemented polyethylene-backed total hip arthroplasty

Kentaro Iwakiri et al. Clin Orthop Relat Res. 2008 May.

Abstract

Alumina-on-alumina bearings for THA have markedly improved in mechanical properties through advances in technology; however, alumina fracture is still a concern. We retrospectively reviewed 77 patients (82 hips) with cemented alumina-on-alumina THAs to identify factors relating to alumina failure. The mean age of the patients at surgery was 63 years. The prostheses had a cemented polyethylene-backed acetabular component with an alumina inlay and a 28-mm alumina head. Revision surgery was performed because of alumina inlay failure in four hips (three fractures and one dissociation; 5.6%), deep infection in two, and recurrent dislocation in one. The 8-year survival rate was 90.7% with revision for any reason and 94.4% with revision for alumina failure as the end point. There were no differences in age, body mass index, gender, mobility, function, abduction angle, or size of component among the four hips with alumina failure and the remaining 68 hips without it; however, radiolucent lines in the sockets were more apparent in four cases with alumina inlay failure. This alumina-on-alumina THA thus yielded unsatisfactory medium-term results because we observed a high rate of catastrophic alumina inlay failure.

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Figures

Fig. 1A–C
Fig. 1A–C
A spherical cemented polyethylene-alumina composite cup, ABS cup (Kyocera, Kyoto, Japan), was developed to obtain stability between the alumina cup and bone cement. There were two designs for this cup: (A) one is the ABS cup without a flange and (B) the other is the ABS cup with a flange. (C) A cross section of the ABS cup is shown. The thickness of the alumina inlay is fixed at 4 mm in any size of acetabular component.
Fig. 2A–B
Fig. 2A–B
The radiographs show alumina inlay failure: (A) fracture of the alumina inlay occurred in three hips without trauma, and (B) dissociation of the alumina inlay from the polyethylene shell occurred in one hip without trauma.
Fig. 3
Fig. 3
Kaplan-Meier survivorship curves of 72 consecutive polyethylene-backed alumina-on-alumina THAs are shown. The 8-year survival rate was 90.7% with revision for any reason and 94.4% with revision for alumina failure as the end point. Dotted lines indicate the 95% confidence intervals.
Fig. 4A–C
Fig. 4A–C
Fretting by the alumina inlay on the stem neck was observed on the radiographs of (A) a patient with dissociation and (B) a patient with a fracture. (C) Macroscopic fretting on the stem neck is shown.
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