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Prevalence of noise after THA did not differ between ceramic-on-ceramic components
LISBON, Portugal — A comparison of two ceramic-on-ceramic total hip arthroplasty components showed no differences in the prevalence of noise at 1 year, according to data presented at the EFORT Annual Congress.
Claus Varnum, MD, PhD, and colleagues randomly assigned patients undergoing ceramic-on-ceramic THA to receive either a Trident hemispheric cup with an ABG II stem (Stryker; n = 86) or a Trilogy cup with a CLS Spotorno stem (Zimmer Biomet; n = 88). Before primary surgery and at 1-year follow-up, researchers collected the EuroQoL-5D index, EQ-5D VAS and University of California at Los Angeles activity level rating.
“Our primary outcome was prevalence of noises 1 year after total hip arthroplasty and our secondary outcomes were [patient-reported outcome measure] PROM scores 1 year postop,” Varnum said in his presentation.
Other than a higher mean age among patients who received the Trident cup, there were no differences in demographics between the two groups.
“There were some differences in the performance characteristics, mainly due to the different designs of the components,” Varnum said.
Varnum noted no significant differences in the prevalence of noise between the two groups, with 17% and 15% of patients who received the Trident cup and the Trilogy cup, respectively, reporting noise.
“There was no difference between mean UCLA, EQ-5D index and VAS at 1 year after total hip between the two groups,” Varnum said. – by Casey Tingle
Reference:
Varnum C, et al. Abstract 3612. Presented at: EFORT Annual Congress; June 5-7, 2019; Lisbon, Portugal.
Disclosure: Varnum reports no relevant financial disclosures.
Perspective
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Noises originating from ceramic-on-ceramic bearing articulations in total hip replacement have been in the focus of attention over the last 15 years. Several research and clinical studies have identified a multitude of contributing factors. There is agreement on the existence of two different kinds of noises, i.e. squeaking and clicking, both being related to the positioning of the implants. Clicking originates from impingement of the stem on the ceramic insert, whereas squeaking is the result of increased friction and consequent (audible) vibration of the components at their natural frequencies. Dependent on implant design, the magnitude of friction increase required to produce audible squeaking varies, making certain designs more vulnerable. Reduced lubrication in the joint articulation is a prerequisite. Any factor influencing lubrication such as small contact areas, metal transfer to the ceramic components, stripe wear resulting from impingement or third bodies are directly related to the problem. In situ the only relevant information, which can be obtained, is the positioning of the implants by imaging. The other factors can only be analyzed after revision. Without information on positioning, conclusions on the influence of design are difficult to make since higher susceptibility of one design could have been compensated by better positioning.
TUHH Hamburg University of Technology