The Exeter-Trident THA with ceramic-on-ceramic-bearings: 10-year outcomes in 275 total hip arthroplasties

Abstract

Aims:

This study reports on the Exeter-Trident total hip arthroplasty (THA) using an alumina ceramic-on-ceramic bearing with 10-year clinical and radiographic follow-up.

Patients and methods:

Between January 2001 and January 2006, 275 THAs were performed. Mean age at surgery was 52.7 (17–86) years, with 84 patients (33.6%) aged <50 years. The primary outcome was all-cause construct survival at minimum 10 years. Secondary outcomes included functional and noise scores. Radiographs were compared between baseline and latest follow-up and assessed for component loosening, migration and lysis.

Results:

No patient was lost to follow-up. Mean follow-up for surviving patients was 12.5 (9.5–15.6) years. Kaplan-Meier survival for all-cause revision was 94.0% (95% CI, 90.5–97.5) at 14.3 years. 2 patients had a femoral component fracture. All scores improved significantly at latest follow-up. HSS-NQ for 247 hips (90.2%) at mean 9.1 (7.0–14.4) years post implantation showed most hips (93.1%) reported no more than occasional noise. At minimum 5 years, radiolucency around the acetabular component was observed in 2 hips (0.8%), and lysis at the interface in 1 hip (0.4%). On the femoral side, endosteal lysis was observed in 7 hips.

Conclusions:

The Exeter-Trident THA with alumina ceramic-on-ceramic bearings performed well in this population. Patients are at low risk of revision in the first decade. However, there is a small risk of stem fracture as a late complication and some patients experience significant noise.

Keywords

Ceramic-on-ceramic bearing hybrid hip squeaking survival total hip arthroplasty

Get full access to this article

View all access options for this article.

References

The NJR Centre. National joint registry for England, Wales, Northern Ireland and Isle of Man. 18th Annual Report 2021. Hemel Hempstead: The NJR Centre, 2021.

Sexton

Yeung

Jackson

, et al. The role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements. J Bone Joint Surg Br 2011; 93: 439–442.

D’Antonio

Capello

Manley

, et al. A titanium-encased alumina ceramic bearing for total hip arthroplasty: 3- to 5-year results. Clin Orthop Relat Res 2005; 441: 151–158.

Miller

Bostrom

, et al. Incidence of ceramic liner malseating in Trident acetabular shell. Clin Orthop Relat Res 2009; 467: 1552–1556.

Langdown

Pickard

Hobbs

, et al. Incomplete seating of the liner with the Trident acetabular system: a cause for concern? J Bone Joint Surg Br 2007; 89: 291–295.

Farhan-Alanie

OMH

Hrycaiczuk

Tinning

, et al. Alumina ceramic-on-ceramic hybrid total hip arthroplasty. A median of 15 years follow-up. Eur J Orthop Surg Traumatol 2022; 32: 1127–1136.

Murray

Fitzpatrick

Rogers

, et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89: 1010–1014.

Harris

. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51: 737–755.

Charnley

. Numerical grading of clinical results. In: Charnley

(ed.) Low friction arthroplasty of the hip: theory and practice. Berlin, Heidleberg, Germany; New York, NY: Springer-Verlag, 1979, pp.20–24.

10.

EuroQol Group. EuroQol - a new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199–208.

11.

Schroder

Bornstein

Bostrom

, et al. Ceramic-on-ceramic total hip arthroplasty: incidence of instability and noise. Clin Orthop Relat Res 2011; 469: 437–442.

12.

Hanly

Crawford

Howell

. Principles of cemented fixation, geometry, surface finish & load transmission. In: Gie

Timperley

Crawford

, et al. (eds.) The Exeter hip: 50 years of innovation in total hip arthroplasty. 2nd ed. Exeter: Exeter Hip Publishing, 2020, pp.23–37.

13.

Fowler

Gie

Lee

, et al. Experience with the Exeter total hip replacement since 1970. Orthop Clin North Am 1988; 19: 477–489.

14.

Kobayashi

Takaoka

Saito

, et al. Factors affecting aseptic failure of fixation after primary Charnley total hip arthroplasty. Multivariate survival analysis. J Bone Joint Surg Am 1997; 79: 1618–1627.

15.

Sporer

Callaghan

Olejniczak

, et al. The effects of surface roughness and polymethylmethacrylate precoating on the radiographic and clinical results of the Iowa hip prosthesis. A study of patients less than fifty years old. J Bone Joint Surg Am 1999; 81: 481–492.

16.

Gruen

McNeice

Amstutz

. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 1979; 141: 17–27.

17.

Barrack

Mulroy

Jr Harris

. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review. J Bone Joint Surg Br 1992; 74: 385–389.

18.

Duncan

Masri

. Fractures of the femur after hip replacement. Instr Course Lect 1995; 44: 293–304.

19.

Maggs

Smeatham

Whitehouse

, et al. The Exeter Contemporary flanged cemented acetabular component in primary total hip arthroplasty. Bone Joint J 2016; 98-B: 307–312.

20.

Brew

Simpson

Whitehouse

, et al. Scaling digital radiographs for templating in total hip arthroplasty using conventional acetate templates independent of calibration markers. J Arthroplasty 2012; 27: 643–647.

21.

Kaplan

Meier

. Non-parametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

22.

Lettin

Ware

Morris

. Survivorship analysis and confidence intervals. An assessment with reference to the Stanmore total knee replacement. J Bone Joint Surg Br 1991; 73: 729–731.

23.

Murray

Carr

Bulstrode

. Survival analysis of joint replacements. J Bone Joint Surg Br 1993; 75: 697–704.

24.

Westerman

Whitehouse

Hubble

MJW

, et al. The Exeter V40 cemented femoral component at a minimum 10-year follow-up. Bone Joint J 2018; 100-B: 1002–1009.

25.

Parvizi

Adeli

Wong

, et al. A squeaky reputation: the problem may be design-dependent. Clin Orthop Relat Res 2011; 469: 1598–1605.

26.

Swanson

Peterson

Seethala

, et al. Influence of prosthetic design on squeaking after ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2010; 25(Suppl.): 36–42.

27.

Taniguchi

Quacinella

Barlow

. Squeaking is common and increases over time among patients with long-term follow-up after ceramic-on-ceramic THA. Clin Orthop Relat Res 2021; 479: 736–744.

28.

Petheram

Whitehouse

Kazi

, et al. The Exeter Universal cemented femoral stem at 20 to 25 years: a report of 382 hips. Bone Joint J 2016; 98-B: 1441–1449.

29.

Hannouche

Zingg

Miozzari

, et al. Third-generation pure alumina and alumina matrix composites in total hip arthroplasty: what is the evidence? EFORT Open Rev 2018; 3: 7–14.

30.

Bolland

Wilson

Howell

, et al. An analysis of reported cases of fracture of the Universal Exeter femoral stem prosthesis. J Arthroplasty 2017; 32: 1318–1322.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.59 MB