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A Simple Technique to Remove an Incarcerated Ceramic Liner in Revision Hip Arthroplasty.

ABSTRACT: Extraction of a well-fixed ceramic liner during revision total hip arthroplasty can be technically challenging, particularly when acetabular fixation screws prevent en bloc removal of the shell and insert without causing collateral damage to the adjacent pelvic bone. It is also important to remove the ceramic liner intact, as ceramic debris left in the joint may cause third body wear with premature articular wear of the revised implants. We describe a novel technique to extract an incarcerated ceramic liner when previously described strategies prove ineffective. Knowledge of this technique will help surgeons avoid unnecessary damage to the acetabular bone and optimize prospects for stable implantation of revision components.

SUBMITTER: Gurung B

PROVIDER: S-EPMC10185739 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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A Simple Technique to Remove an Incarcerated Ceramic Liner in Revision Hip Arthroplasty.

Gurung Binay B Shah Owais A OA Edwards Thomas C TC Afzal Irrum I Gikas Panagiotis D PD Field Richard E RE

Arthroplasty today 20230506

Extraction of a well-fixed ceramic liner during revision total hip arthroplasty can be technically challenging, particularly when acetabular fixation screws prevent en bloc removal of the shell and insert without causing collateral damage to the adjacent pelvic bone. It is also important to remove the ceramic liner intact, as ceramic debris left in the joint may cause third body wear with premature articular wear of the revised implants. We describe a novel technique to extract an incarcerated c ...[more]

PMID: 37205270

Similar Datasets

A simple technique to remove well-fixed acetabular components in revision of total hip arthroplasty.

Project description:Removing well-fixed acetabular components can be a challenge for orthopaedic surgeons in revision of total hip arthroplasty. Acetabular bone loss, fracture, and other complications occurred in extracting implants may result in instability and fail of revision. Thus, instruments are developed to avoid such complications. We report a simple technique by drilling a tunnel on the superolateral quadrant of acetabulum and using an offset staff to remove acetabular components without many matching units. The procedure of removing well-fixed acetabular components is a simple, efficient, inexpensive, bone stock preserving technique.

| S-EPMC5712023 | biostudies-literature

Ceramic liner fracture and impingement in total hip arthroplasty.

Project description:BackgroundCeramic-on-ceramic bearing surfaces were developed to provide an alternate to metal-on-polyethylene to decrease wear-induced osteolysis in total hip arthroplasty patients. In an effort to decrease the risk of ceramic acetabular component fracture or damage during implantation, a raised metal rim was added.Questions/purposesHow many fractures or impingements have occurred in our population of patients with ceramic liners with raised rims?MethodsWith IRB-approved consent, a case series was reviewed from a single center registry and 4 of 169 patients were identified who had revision hip surgery with the ceramic liner with a raised metal rim: one for ceramic liner fracture and three for metallosis, pain, and squeaking. Implant alignment and operative findings were reviewed.ResultsOne ceramic liner fracture and three cases of metallosis from impingement of the femoral neck on the posterior elevated metal rim of the acetabular liner were observed at revision. The femoral neck in each patient had a divot that corresponded to a divot in the posterosuperior liner rim. Three of the four patients had audible squeaking or clicking prior to revision. A total of 3% of patients in this series had clinically significant impingement with this implant type.ConclusionAcoustic phenomenon in a ceramic on ceramic bearing surface should be investigated with a cross-table lateral radiograph to evaluate component position. If symptomatic impingement is demonstrated, revision should be considered to avoid failure from metallosis or fracture.

| S-EPMC4342397 | biostudies-literature

Cementation of a Metal Dual Mobility Liner in Patients Undergoing Revision Total Hip Arthroplasty

Project description: Not available

| S-EPMC10704222 | biostudies-literature

Severe Wear and multiple Pseudotumor formation due to revision for ceramic head breakage after ceramic-on-ceramic Total hip arthroplasty: a case report.

Project description:BACKGROUND:Head breakage is a serious complication following total hip arthroplasty when using Ceramic on Ceramic bearings surfaces. There is still in controversy about the selection of bearing surfaces when conducting revision surgery. CASE PRESENTATION:We describe the case of a fifty-year-old man who had undergone right total hip arthroplasty (THA) with ceramic-on-ceramic prostheses in 2011. After a fall 6 years after the primary procedures, radiographs suggested a ceramic head breakage for revision THA with exchange of metal-on-polyethylene bearing. However, 8 months later, severe metallosis and multiple pseudotumor was confirmed in pelvis and surrounding hip after re-revision THA with ceramic-on-polyethylene prostheses. Analysis of the serum metal ion indicated massive wear of the metal head and erosion of the stem neck and taper. CONCLUSIONS:This case vividly demonstrates metal bearings should be avoided and revision with complete synovectomy and thorough debridement should be performed whenever possible for a fractured ceramic bearing.

| S-EPMC6637575 | biostudies-literature

Osteosarcoma Around a Ceramic-on-Ceramic Total Hip Arthroplasty.

Project description:Sarcoma arising at the site of a total hip arthroplasty (THA) is uncommon. We present a case report of a patient diagnosed with an osteosarcoma around a ceramic-on-ceramic THA and a narrative literature review of sarcomas around THA. A search of PubMed MEDLINE was performed from inception. Our case report was included in the analysis. A total of 13 studies were included in the review. We report the first case of a sarcoma around a ceramic-on-ceramic hip implant. All cases in the literature reported poor outcomes with an average time from index THA to diagnosis of 9.3 ± 8.2 years. Sarcomas around THA are extremely rare. Despite the rarity of the diagnosis, osteosarcoma must be considered in the differential diagnosis when investigating a periprosthetic mass.

| S-EPMC9874008 | biostudies-literature

Inflammatory pseudotumor after ceramic-on-ceramic total hip arthroplasty.

Project description:We present a unique case of a symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface. To our knowledge, this pathological finding has not yet been described in a ceramic-on-ceramic articulation without a cobalt-chromium alloy trunnion or modular neck component as a source of metal wear. We conclude that despite its mechanical mostly benign wear characteristics, ceramic wear debris is not entirely inert and may lead to the development of adverse local tissue reaction.

| S-EPMC5485220 | biostudies-literature

Surgical technique: a simple technique for closing the capsule of the hip in posterolateral approach total hip arthroplasty.

Project description:BackgroundRepair of the posterior soft tissue via a posterolateral approach following total hip arthroplasty has been reported to mitigate the risk of dislocation. The joint capsule serves as the primary protective barrier, and while previous techniques for closure have been predominantly complex, we present a novel, simplified technique for joint capsule closure.MethodsA total of 215 patients who underwent primary THA via the posterolateral approach at our hospital from May 2018 to December 2022 were retrospectively enrolled in this study: 111 patients had their joint capsules sutured using traditional methods, while 114 patients had their joint capsules sutured using the new technology.ResultsCompared to the traditional suture group, the novel joint capsular suture group exhibited shorter operation times (p = 0.004) and reduced postoperative drainage volumes (p < 0.001). There were no significant differences in intraoperative blood loss, acetabular anteversion angle and abduction angle between the two groups. Although the Harris scores at 2 weeks, 3 months, and 6 months after surgery were marginally greater in the novel joint capsular suture group than in the traditional suture group, these differences did not reach statistical significance. Regarding adverse reactions observed during follow-up, hematoma occurred in seven patients (6.6%), and dislocation occurred in four patients (3.6%) in the traditional suture group; conversely, within the new joint capsule suture group, there were only two patients (1.8%) of hematoma with no instances of dislocation recorded thus far.ConclusionsThe preliminary results show that this new capsular closure technique allows the joint capsule to close more tightly and is an effective technique for reducing the rate of early postoperative dislocation.

| S-EPMC11869475 | biostudies-literature

Ceramic-on-Ceramic Total Hip Arthroplasty: I Can Hear You

Project description: Not available

| S-EPMC10517284 | biostudies-literature

Ceramic-on-ceramic bearings total hip arthroplasty in young patients.

Project description:BackgroundThe results of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in younger patients were not univocal. This study aims to evaluate the results of CoC bearing THA in patients younger than 50 years.MethodsA total of 90 younger patients performed CoC THAs during March 2003 and May 2008 were included in this study. Hip function and activity were evaluated with Harris hip score and University of California Los Angeles activity score. We had discussed survival rates, radiological findings of component loosening or osteolysis, and ceramic-related complications in these patients.ResultsThe mean Harris hip score increased from 46.3 ± 12.0 points (range, 28-70 points) before surgery to 92.5 ± 5.6 points (range, 78-100 points) at the final follow-up. The mean preoperative University of California Los Angeles activity score was 4.2 ± 1.1 points (range, 2-6 points), which improved to a mean of 7.2 ± 1.3 points (range, 4-10 points). At the time of the last follow-up, there was found to be 1 occurrence of hip dislocation, 1 squeaking, and 2 "sandwich" ceramic liners fractured during normal activity of daily living. No hips showed osteolysis or required revision for aseptic loosening. Kaplan-Meier survivorship with revision due to loosening or osteolysis was 100% and with revision due to ceramic fracture was 97.3% (95% confidence interval, 93.7%-100%) at a mean of 9.4 years.ConclusionsThis study with the use of CoC bearings THAs in younger patients have shown promising results and higher rate of survivorship without evidence of osteolysis.

| S-EPMC5247519 | biostudies-literature

Incidence of 'squeaking' after ceramic-on-ceramic total hip arthroplasty.

Project description:UnlabelledThe incidence of hip "squeak" associated with ceramic-on-ceramic bearings has been variably reported, ranging from 0.7% to 20.9%. We determined the patients' perception of squeaking in 306 patients (336 hips) in whom ceramic-on-ceramic total hip arthroplasties (THAs) were performed between 1997 and 2005. A questionnaire regarding hip noise was obtained by telephone. With a minimum followup of 2 years (mean, 3.9 years; range, 2-10 years), 290 patients (320 or 95% of the THAs) completed the questionnaire. Patients reported hip noise in 55 of the 320 THAs (17%); noise was perceived as squeak in 32 of the 320 (10%). Most squeaking hips (29 of 32) were pain-free and symptom-free. One patient was unhappy with his squeaking hip without pain. Our data suggest a much higher incidence of squeak as perceived by patients than previously reported.Level of evidenceLevel II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

| S-EPMC2806984 | biostudies-literature

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