Gunn Christopher, Thakker Vivek, Williams Sophie, Board Timothy N, Wynn-Jones Henry, Barrow Jonathan
Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UK.
Institute of Medical and Biological Sciences, University of Leeds, Leeds, UK.
Bone Jt Open. 2025 Jun 13;6(6):700-706. doi: 10.1302/2633-1462.66.BJO-2025-0030.R1.
Ceramic bearing fracture is a rare complication following implantation using modern ceramic bearing materials. The ideal revision bearing option in such cases is debated. We aimed to investigate the safety of a hard on soft bearing following ceramic fracture in total hip arthroplasty.
Data on all patients undergoing revision following ceramic fracture between January 2016 and January 2019 were collected retrospectively. Templating software was used to determine linear wear between the first post-revision radiograph and latest available follow-up. Univariate analysis was used to examine patient demographics and the wear rates of the polyethylene components. The intra- and inter-rater reliability of wear measurements was calculated. Additionally, in vitro testing was undertaken to assess the effects on bearing surfaces of residual ceramic particles.
A total of 12 patients underwent revision for ceramic fracture in the study period. The mean age at revision was 62 years (54 to 72). There were six liner and six head fractures revised to delta ceramic heads and cross-linked polyethylene acetabular components. At mean follow-up of 3.8 years (0.5 to 6.1), median 4.4 years (IQR 2.0 to 5.1), linear wear rate was calculated at 0.08 mm/year (SD 0.06). Both intra- and inter-rater reliability was excellent with intraclass correlation coefficient (ICC) scores of 0.99 at all timepoints. In vitro testing showed an increase in head roughness in metal on polyethylene bearings after ceramic particles were embedded, but no increase in ceramic on polyethylene (CoP) or ceramic on ceramic bearings.
Revision to CoP bearings following ceramic fracture does not cause early catastrophic wear at early follow-up, aligning with the in vitro study observations. It appears safe to use this hard on soft bearing combination, given that wear rates are comparable to what is expected in a primary hip arthroplasty setting. Longer follow-up is required to establish if this trend persists.
使用现代陶瓷轴承材料进行植入后，陶瓷轴承骨折是一种罕见的并发症。此类情况下理想的翻修轴承选择存在争议。我们旨在研究全髋关节置换术中陶瓷骨折后硬对软轴承的安全性。
回顾性收集2016年1月至2019年1月期间所有因陶瓷骨折接受翻修手术的患者的数据。使用模板软件确定翻修后首张X线片与最新可用随访之间的线性磨损情况。采用单因素分析来检查患者人口统计学特征以及聚乙烯组件的磨损率。计算磨损测量的评分者内和评分者间可靠性。此外，进行了体外测试以评估残留陶瓷颗粒对轴承表面的影响。
在研究期间，共有12例患者因陶瓷骨折接受翻修手术。翻修时的平均年龄为62岁（54至72岁）。有6例衬垫骨折和6例股骨头骨折翻修为德尔塔陶瓷股骨头和交联聚乙烯髋臼组件。平均随访3.8年（0.5至6.1年），中位数4.4年（四分位间距2.0至5.1年），计算出线性磨损率为0.08毫米/年（标准差0.06）。评分者内和评分者间可靠性均极佳，所有时间点的组内相关系数（ICC）得分均为0.99。体外测试表明，陶瓷颗粒嵌入后，金属对聚乙烯轴承的头部粗糙度增加，但聚乙烯对陶瓷（CoP）或陶瓷对陶瓷轴承未增加。
陶瓷骨折后翻修为CoP轴承在早期随访中不会导致早期灾难性磨损，这与体外研究观察结果一致。鉴于磨损率与初次髋关节置换术中预期的相当，使用这种硬对软轴承组合似乎是安全的。需要更长时间的随访来确定这种趋势是否持续。
