Seyler, Thorsten M.; Bonutti, Peter M.; Jianhua Shen; Naughton, Marybeth; Kester, Mark
November 2006
Journal of Bone & Joint Surgery, American Volume;Nov2006 Supplement 3, Vol. 88-A, p116
Academic Journal
Background: The results of total hip arthroplasty in patients with osteonecrosis of the femoral head are not always optimal. The use of alumina-on-alumina interfaces in young and active patients may decrease wear and lower the rate of aseptic loosening of the implant and appears to be an attractive alternative to the use of conventional cobalt-chromium-on-polyethylene bearings. The purpose of this study was to evaluate the safety and efficacy of the alumina-on-alumina bearing in patients with osteonecrosis and to compare this group of patients to a group of similarly treated patients with osteoarthritis and a group of patients who received conventional cobalt-chromium-on-polyethylene bearings. Methods: Patients were selected from a United States Investigational Device Exemption multicenter prospective randomized clinical study that was initiated in 1996. Seventy patients with osteonecrosis of the femoral head (seventy-nine hips) received a cementless alumina-on-alumina bearing system and were directly matched to seventy-six patients with osteoarthritis of the hip (seventy-nine hips) who were managed with the same implant. Both groups were compared with twenty-five patients (twenty-six hips) with osteonecrosis and twenty-five patients (twenty-six hips) with osteoarthritis who were managed with a cementless cobalt-chromium-on-polyethylene bearing system. All patients received a cementless hydroxyapatite-coated femoral stem and were followed both clinically and radiographically. Results: The clinical outcomes for alumina-on-alumina bearings were similar for both osteonecrotic and osteoarthritic hips. The seven-year survival probability was 95.5% for the osteonecrotic hips and 89.4% for the osteoarthritic hips in the alumina-on-alumina bearing group and 92.3% for the osteonecrotic hips and 92.9% for the osteoarthritic hips in the cobalt-chromium-on-polyethylene bearing group. At the time of the most recent follow-up, the mean Harris hip score was 96 points for both the osteonecrotic and the osteoarthritic hips in the alumina-on-alumina group and 96 points for the osteonecrotic hips and 97 points for the osteoarthritic hips in the cobalt-chromium-on-polyethylene bearing group. Conclusions: The results of the use of alumina-on-alumina and cobalt-chromium-on-polyethylene bearings in cementless standard total hip implants in patients with osteonecrosis and osteoarthritis were comparable. The low revision rate for the alumina-on-alumina bearing is encouraging and offers a promising option for younger, more active patients who have this challenging disease. Level of Evidence: Therapeutic Level III. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.


Related Articles

  • METAL-ON-METAL HIP RESURFACING IN OSTEONECROSIS OF THE FEMORAL HEAD. Revell, Matthew P.; McBryde, Callum W.; Bhatnagar, Sharad; Pynsent, Paul B.; Treacy, Ronan B. C. // Journal of Bone & Joint Surgery, American Volume;Nov2006 Supplement 3, Vol. 88-A, p98 

    Background: The treatment of end-stage osteonecrosis of the femoral head remains a challenge to the orthopaedic surgeon. Historically, total hip arthroplasty for this condition has been associated with poor rates of survival and function when compared with total hip arthroplasty for the...

  • USE OF METAL-ON-METAL TOTAL HIP RESURFACING FOR THE TREATMENT OF OSTEONECROSIS OF THE FEMORAL HEAD. Mont, Michael A.; Seyler, Thorsten M.; Marker, David R.; Marulanda, German A.; Delanois, Ronald E. // Journal of Bone & Joint Surgery, American Volume;Nov2006 Supplement 3, Vol. 88-A, p90 

    Background: Recently, with the advent of improved metal-on-metal prostheses, total hip resurfacing has emerged as a viable arthroplasty option. However, it remains controversial whether this procedure should be used in patients with osteonecrosis when the femoral resurfacing component is...

  • A review of pre-clinical testing of femoral stem subsidence and comparison with clinical data. Gheduzzi, S.; Miles, A. W. // Proceedings of the Institution of Mechanical Engineers -- Part H;Jan2007, Vol. 221 Issue 1, p39 

    Immediate postoperative stability of femoral stems is one of the key factors for the long-term success of total hip replacement. The need to develop a reliable technique to assess in vitro implant stability under physiological loading conditions is widely recognized. A critical review of the in...

  • Periprosthetic bone mineral density with a cementless triple tapered stem is dependent on daily activity. Hayashi, Shinya; Nishiyama, Takayuki; Fujishiro, Takaaki; Kanzaki, Noriyuki; Hashimoto, Shingo; Kurosaka, Masahiro // International Orthopaedics;Jun2012, Vol. 36 Issue 6, p1137 

    Purpose: Periprosthetic bone loss around the femoral stem is frequently found after total hip arthroplasty. We have shown that periprosthetic bone mineral density (BMD) loss using the triple tapered stem is consistently much less in comparison with the straight type component. In this study, we...

  • Accuracy of a computer-assisted navigation system in resurfacing hip arthroplasty. Pitto, R.; Malak, S.; Anderson, I. // International Orthopaedics;Apr2009, Vol. 33 Issue 2, p391 

    We developed a method to assess the accuracy of an image-free resurfacing hip arthroplasty navigation system in a proximal femur with normal and abnormal anatomy. A phantom lower limb allowed deformation in varus/valgus and ante-retroversion. At specific points during the simulated surgical...

  • Anatomic stem design reduces risk of thin cement mantles in primary hip replacement. Hank, Christian; Schneider, Michael; Achary, Cheryl S.; Smith, Leslie; Breusch, Steffen J. // Archives of Orthopaedic & Trauma Surgery;Jan2010, Vol. 130 Issue 1, p17 

    To analyse the influence of femoral stem design in the lateral plane (anatomic vs. straight) on the cement mantle quality. In this consecutive multi-surgeon radiographic study we determined, Dorr grading, cement mantle quality (Barrack) and mantle thickness using Gruen zones 1–14 in 280...

  • Range of motion measurement of an artificial hip joint using CT images. Sun, Haosheng; Inaoka, Hidenori; Fukuoka, Yutaka; Masuda, Tadashi; Ishida, Akimasa; Morita, Sadao // Medical & Biological Engineering & Computing;Dec2007, Vol. 45 Issue 12, p1229 

    Total hip arthroplasty (THA) is one of the most effective treatments for osteoarthritis and rheumatoid arthritis. Dislocation of the femoral head from the acetabular socket is a major problem of THA. To prevent dislocation, it is important to know the range of motion (ROM) after THA. Although...

  • Bearing Surface Options for Total Hip Replacement in Young Patients. Heisel, Christian; Silva, Mauricio; Schmalzried, Thomas P. // Journal of Bone & Joint Surgery, American Volume;Jul2003, Vol. 85-A Issue 7, p1366 

    Total hip arthroplasty is one of the most successful and cost-effective surgical interventions in medicine and is the most effective treatment for osteoarthritis of the hip joint. On the basis of this success, total hip replacement is being performed on increasingly younger and more active...

  • Midterm results of cementless total hip replacement in rapidly destructive arthropathy and a review of the literature. PETERS, KARIN S.; DOETS, H. CORNELIS // Hip International;Oct-Dec2009, Vol. 19 Issue 4, p352 

    BACKGROUND AND PURPOSE: Rapidly destructive arthropathy (RDA) of the hip is a disease of unknown etiology characterized by a rapid destruction of the acetabular and femoral aspects of the hip joint. The purpose of this study was to assess the outcome of cementless total hip replacement in this...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics