Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Orthop Res. 2011 Feb;29(2):218-22. doi: 10.1002/jor.21246. Epub 2010 Sep 23.
Although impingement between the neck of the metallic stem and the ceramic liner has been suspected to be the cause of ceramic liner failure in ceramic-on-ceramic total hip arthroplasty (THA), no report has directly demonstrated microscopic damage on ceramic liner. We performed 18 reoperations on 18 patients who had undergone third generation ceramic-on-ceramic THA. Considering impingement, 16 patients, who were reoperated more than 1 year after previous ceramic bearing THA, were evaluated. Retrieved alumina liners, showing evidence of impingement, were examined by means of visual inspection and scanning electron microscopy (SEM). Four of the 16 hips showed neck notching and black stained liners, evidence of metallic neck to ceramic impingement. Impinged alumina bearings had been implanted for an average of 62.5 months (range: 35-99 months) before reoperation. SEM of the black stained area demonstrated disruptive wear and loss of surface integrity. Furthermore, one liner had multiple microcracks, and its cross-sectional SEM analysis revealed one microcrack propagating into the deep portion of the ceramic liner. Our observations suggest that metal neck-to-ceramic impingement in ceramic-on-ceramic THA can cause microcrack formation in ceramic liner.
虽然金属柄颈部与陶瓷衬里之间的碰撞已被怀疑是陶瓷对陶瓷全髋关节置换术（THA）中陶瓷衬里失效的原因，但尚无报告直接证明陶瓷衬里存在微观损伤。我们对 18 名接受第三代陶瓷对陶瓷 THA 的患者进行了 18 次翻修手术。考虑到碰撞，对 16 名在前一次陶瓷轴承 THA 后超过 1 年再次接受手术的患者进行了评估。通过肉眼观察和扫描电子显微镜（SEM）检查取出的氧化铝衬里，发现有撞击证据。有 4 个髋关节的颈部有凹陷，且陶瓷衬里有黑色染色，这表明存在金属颈与陶瓷的碰撞。在再次手术前，受影响的氧化铝轴承已植入平均 62.5 个月（范围：35-99 个月）。对黑色染色区域的 SEM 分析显示了破坏性磨损和表面完整性丧失。此外，一个衬里有多个微裂纹，其横截面 SEM 分析显示一个微裂纹向陶瓷衬里的深部扩展。我们的观察结果表明，陶瓷对陶瓷 THA 中的金属颈与陶瓷碰撞会导致陶瓷衬里中形成微裂纹。
