Publications & Reports

Ceramic-on-Polyethylene Bearing Usage in Primary THA Is Associated with Reduced Readmission Risk for the Medicare Population

The authors hypothesized that unplanned readmissions, which are often caused by infections and dislocation, may be reduced with ceramic bearing usage. They also sought to confirm that the readmission rates for ceramic bearings were associated with the year of surgery. The authors also found that C-PE bearings were associated with significantly reduced readmission risk relative to M-PE at 30 days (hazard ratio [HR]: 0.91, p <ā€‰0.001) and 90 days (HR: 0.93, pā€‰<ā€‰0.001). In terms of strength of association with 90-day readmission, however, it was ranked the ninth most associated independent factor. To the authors' knowledge, this is the first study to demonstrate an association between THA implant characteristics (in this case C-PE bearing usage) and reduced readmission rates in this context along with patient- and clinical-related factors. The readmission rates for COC were found to be comparable to M-PE.

Are Ceramic Bearings Becoming Cost-Effective for all Patients?

The purpose of this study was to analyze whether the cost for ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) bearings used in primary total hip arthroplasty was changing over time, and if the cost differential between ceramic bearings and metal-on-polyethylene (M-PE) bearings was approaching the previously published tipping point for cost-effectiveness of $325. Patient and clinical factors had a far greater impact on the cost of inpatient THA surgery than bearing selection. Because we found that costs and cost differentials for ceramic bearings were decreasing over time, and approaching the tipping point, it is likely that the cost-effectiveness thresholds relative to M-PE are likewise changing over time and should be revisited in light of the present study.

Fretting and Corrosion Damage in Taper Adapter Sleeves for Ceramic Heads: a Retrieval Study

The purpose of this study was to investigate fretting corrosion in sleeved ceramic heads in retrieved total hip arthroplasties.The fretting corrosion scores in this study were predominantly mild and lower than reported fretting scores of cobalt-chrome heads in metal-on-polyethylene bearings. Although intended for use in revisions, researchers found that the short-term in vivo corrosion behavior of the sleeves was similar in both primary and revision surgery applications. From an in vivo corrosion perspective, sleeves are a reasonable solution for restoring the stem taper during revision surgery.

Outcomes of Ceramic Bearings After Primary Total Hip Arthroplasty in the Medicare Population

The purpose of this study was to analyze the outcomes of ceramic bearings used in primary total hip arthroplasty (THA) in the Medicare population. As in previous studies, researchers found that ceramic bearings have similar overall revision risk as M-PE bearings in primary THA at 8-9 years of follow-up. The results indicate that, after adjusting for selection bias and various confounding patient-, surgeon-, and hospital-related factors, Medicare primary THA patients treated with ceramic bearings exhibit lower risk of infection than those treated with M-PE bearings. In addition, C-PE bearings were associated with lower risk of dislocation and mortality.

Outcomes of Ceramic Bearings After Revision Total Hip Arthroplasty in the Medicare Population

The purpose of this study was to analyze the utilization and outcomes of ceramic bearings used in revision total hip arthroplasty (R-THA) in the Medicare population. A total of 31,809 patients aged >65 years at the time of revision surgery who underwent R-THA between 2005 and 2013 were identified from the United States Medicare 100% national administrative claims database. Medicare patients treated in a revision scenario with ceramic bearings exhibited similar risk of rerevision, infection, or mortality as those treated with metal-on-polyethylene bearings. Conversely, researchers found an association between the use of specific ceramic bearings in R-THA and reduced risk of readmission (C-PE) and dislocation (COC).

Ceramic Heads Decrease Metal Release Caused by Head-Taper Fretting and Corrosion

In this study, researchers from Drexel University quantified the volumetric material loss from the head bore and stem cone tapers of a matched cohort of ceramic and metal heads. A quantitative method was developed to estimate volumetric material loss from the head and stem taper in previously matched retrieval cohorts of 50 ceramic and 50 CoCr head-stem pairs. An order of magnitude reduction in volumetric material loss was found when a ceramic head was used instead of a CoCr head. The researchers found that ceramic femoral heads were an effective means by which to reduce metal release caused by taper fretting and corrosion at the head bore-stem cone modular interface in THAs.

Metal Transfer on Retrieved Ceramic and CoCr Femoral Heads

Metal transfer has been observed on retrieved THA femoral heads for both CoCr and ceramic bearing materials. Researchers investigated the extent of metal transfer on the bearing surface of CoCr and ceramic femoral heads and identified prevalent morphologies. Three bearing couple cohorts were studied: M-PE (n=50), C-PE (n=35), and C-C (n=15). Surface area coverage and curved median surface area were similar among the three cohorts. The most prevalent metal transfer patterns observed were random stripes, longitudinal stripes, and random patches. Metal transfer arc length was shorter in the M-PE cohort.

Ceramic Femoral Heads Reduce Taper Fretting Corrosion Damage in Hip Arthroplasty

Researchers from Drexel University have investigated whether ceramic femoral heads reduce taper fretting and corrosion damage when compared with cobalt chrome (CoCr) alloy femoral heads. A matched cohort design was used in which 50 ceramic head-stem pairs were matched with 50 CoCr head-stem pairs. The results suggest that using a ceramic femoral head mitigates CoCr fretting and corrosion from the modular head-neck taper interface.

Strength and Reliability of Alumina Ceramic Femoral Heads: A Review

This review paper summarizes the published literature regarding alumina ceramic femoral heads and tries to identify areas where uncertainties remain. We will discuss the following topics: (1) the fracture mechanics of ceramic materials; (2) design-related stresses acting on the femoral head, especially at the interface between the stem trunnion and the head; (3) gradual loss of strength in service by fatigue or slow crack growth and simulation using a proof test; and (4) information that can be gathered from examination of fractured explants.