Background: Asian cultures require floor-seated positions demanding a high range of motion
(ROM). Ceramic-On-Ceramic (COC) interface allowed the use of larger head with reduced
wear debris generation and adverse tissue reactions. This study was conducted to
analyze 6-year clinical-radiological outcome with large head fourth generation DeltaMotion® ceramic-on-ceramic (COC) hip articulation, with special
emphasis on postoperative ROM, ability to sit cross-legged, stability, hip noise
and revision surgery. Material and Methods: 150 consecutive hips were operated
for primary cementless Total Hip Replacement (THR) using DeltaMotion® at a tertiary care center in Mumbai, India, between
January 2010 and January 2015. Clinico-radiological outcome was assessed using the
Harris Hip Score (HHS) and radiographs at 6 weeks, 6 months, and annually thereafter. Results: 108 (74.5%) patients were males and 37 (25.5%) were females with
an average age of 50.87 years. Mean follow-up was 54
months (range: 37 - 86 months).
The mean ROM was 120° in flexion, 10° in extension, 30° in adduction, 45° in abduction,
25° in internal rotation and 25° in external rotation. The mean HHS showed a statistically
significant improvement of 64.5% (from 54.66 ± 6.42 pre-operatively to 89.95 ± 4.32
post operatively) (p-value: 0.001). 92% of patients were able to sit in squatting
position and 92% were able to sit cross-legged on the floor at last follow-up. 0.7% joints (1 hip) had squeaking. Considering no
revision surgery as the end point, 6-year prosthesis survivorship was 100%. Complications
(superficial infection) occurred in three hips (2%). All patients reported to be satisfied with their outcome after surgery. Conclusion: We infer that DeltaMotion large head COC bearing allows scope for using larger
head size in relatively smaller Indian hips due to factory fitted ceramic lining.
At 6-year follow-up, high activity level was observed with excellent clinical-radiological
outcomes and component longevity in relatively young Indian population.
References
[1]
Mulholland, S.J. and Wyss, U.P. (2001) Activities of Daily Living in Non Western Cultures: Range of Motion Requirements for Hip and Knee Joint Implants. International Journal of Rehabilitation Research, 24, 191-198. https://doi.org/10.1097/00004356-200109000-00004
[2]
Prakash, V.R., Patel, S., Hariohm, K.S., Soni, V. and Alagumoorthi, G. (2016) Importance of Squatting and Sitting on the Floor: Perspectives and Priorities of Rural Indian Patients with Stroke. Topics in Stroke Rehabilitation, 23, 240-244. https://doi.org/10.1080/10749357.2016.1151693
[3]
Baker, R.P., Pollard, T.C., Eastaugh-Waring, S.J. and Bannister, G.C. (2011) A Medium-Term Comparison of Hybrid Hip Replacement and Birmingham Hip Resurfacing in Active Young Patients. The Journal of Bone & Joint Surgery, British, 93B, 158-163. https://doi.org/10.1302/0301-620X.93B2.25625
[4]
Mont, M.A., Marker, D.R., Smith, J.M., Ulrich, S.D. and McGrath, M.S. (2009) Resurfacing Is Comparable to Total Hip Arthroplasty at Short-Term Follow-Up. Clinical Orthopaedics and Related Research, 467, 66-71. https://doi.org/10.1007/s11999-008-0465-3
[5]
Lavigne, M., Therrien, M., Nantel, J., Roy, A., Prince, F. and Vendittoli, P.A. (2010) The John Charnley Award: The Functional Outcome of Hip Resurfacing and Large-Head THA Is the Same: A Randomized, Double-Blind Study. Clinical Orthopaedics and Related Research, 468, 326-336. https://doi.org/10.1007/s11999-009-0938-z
[6]
Agarwala, S., Mohrir, G. and Moonot, P. (2014) Functional Outcome Following a Large Head Total Hip Arthroplasty: A Retrospective Analysis of Mid Term Results. Indian Journal of Orthopaedics, 48, 410-414. https://doi.org/10.4103/0019-5413.136295
[7]
Neumann, D.R., Thaler, C., Hitzl, W., Huber, M., Hofstadter, T. and Dorn, U. (2010) Long Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty: A 10-Year Follow-Up Study. The Journal of Arthroplasty, 25, 700-708. https://doi.org/10.1016/j.arth.2009.05.018
[8]
Langton, D.J., Jameson, S.S., Joyce, T.J., Gandhi, J.N., Sidaginamale, R.P., Mereddy, P.K., Lord, J.K. and Nargol, V.F.A. (2011) Accelerating Failure Rate of the ASR Total Hip Replacement. Journal of Bone and Joint Surgery, British, 93B, 1011-1016.
[9]
Boutin, P. (2014) Total Arthroplasty of the Hip by Fritted Alumina Prosthesis. Experimental Study and 1st Clinical Applications. Orthopaedics & Traumatology: Surgery & Research, 100, 15-21. https://doi.org/10.1016/j.otsr.2013.12.004
[10]
Yoon, H.J., Yoo, J.J., Yoon, K.S., Koo, K.H. and Kim, H.J. (2012) Alumina-on-Alumina THA Performed in Patients Younger than 30 Years: A 10-Year Minimum Follow-Up Study. Clinical Orthopaedics and Related Research, 470, 3530-3536. https://doi.org/10.1007/s11999-012-2493-2
[11]
Kang, B.J., Ha, Y.C., Ham, D.W., Hwang, S.C., Lee, Y.K. and Koo, K.H. (2015) Third-Generation Alumi-na-on-Alumina Total Hip Arthroplasty: 14 to 16-Year Follow-Up Study. The Journal of Arthroplasty, 30, 411-415. https://doi.org/10.1016/j.arth.2014.09.020
[12]
Toni, A., Giardina, F., Guerra, G., Sudanese, A., Montalti, M., Stea, S. and Bordini, B. (2017) 3rd Generation Alumina-on-Alumina in Modular Hip Prosthesis: 13 to 18 Years Follow-Up Results. HIP International, 27, 8-13. https://doi.org/10.5301/hipint.5000429
[13]
Sugano, N., Takao, M., Sakai, T., Nishii, T., Miki, H. and Ohzono, K. (2012) Eleven-to 14-Year Follow-Up Results of Cementless Total Hip Arthroplasty Using a Third-Generation Alumina Ceramic-on-Ceramic Bearing. The Journal of Arthroplasty, 27, 736-741. https://doi.org/10.1016/j.arth.2011.08.017
[14]
Porat, M., Parvizi, J., Sharkey, P.F., Berend, K.R., Lombardi, A.V.Jr. and Barrack, R.L. (2012) Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties. Clinical Orthopaedics and Related Research, 470, 382-387. https://doi.org/10.1007/s11999-011-2161-y
[15]
Gagala, J., Mazurkiewicz, T. and Dajewski, Z. (2011) Large Diameter Femoral Heads in Primary Alumi-na/Alumina and XSPE/Alumina Total Hip Arthroplasty. A Follow-Up Study of 50 Hips after Average 40 Months and Review of Literature. Chir Narzadow Ruchu Ortop Pol, 76, 14-20.
[16]
McDonnell, S.M., Boyce, G., Baré, J., Young, D. and Shimmin, A.J. (2013) The Incidence of Noise Generation Arising from the Large-Diameter Delta Motion Ceramic Total Hip Bearing. The Bone & Joint Journal, 95B, 160-165. https://doi.org/10.1302/0301-620X.95B2.30450
[17]
Chan, H.Y., Koo, K.H., Jeong, S.T., Yoo, J.J., Kim, Y.M. and Kim, H.J. (2007) Cementless Alumina-on-Alumina Total Hip Replacement in Patients Younger than 50 Years—A 5-Year Minimum Follow-Up Study. The Journal of Arthroplasty, 22, 184-188. https://doi.org/10.1016/j.arth.2006.02.169
[18]
Morshed, S., Bozic, K.J., Ries, M.D., Malchau, H. and Colford, J.M.Jr. (2007) Comparison of Cemented and Uncemented Fixation in Total Hip Replacement: A Meta-Analysis. Acta Orthopaedica, 78, 315-326. https://doi.org/10.1080/17453670710013861
[19]
Cuckler, J.M., Moore, K.D., Lombardi, A.V.Jr., McPherson, E. and Emerson, R. (2004) Large versus Small Femoral Heads in Metal-on-Metal Total Hip Arthroplasty. The Journal of Arthroplasty, 19, 41-44. https://doi.org/10.1016/j.arth.2004.09.006
[20]
Hummel, M.T., Malkani, A.L., Yakkanti, M.R. and Baker, D.L. (2009) Decreased Dislocation after Revision Total Hip Arthroplasty Using Larger Femoral Head Size and Posterior Capsular Repair. The Journal of Arthroplasty, 24, 73-76. https://doi.org/10.1016/j.arth.2009.04.026
[21]
Amstutz, H.C., Lodwig, R.M., Schurman, D.J. and Hodgson, A.G. (1975) Range of Motion Studies for Total Hip Replacements. A Comparative Study with a New Experimental Apparatus. Clinical Orthopaedics and Related Research, 111, 124-130. https://doi.org/10.1097/00003086-197509000-00016
[22]
Elkins, J.M., Callaghan, J.J. and Brown, T.D. (2014) Stability and Trunnion Wear Potential in Large-Diameter Metal-on-Metal Total Hips: A Finite Element Analysis. Clinical Orthopaedics and Related Research, 472, 529-542. https://doi.org/10.1007/s11999-013-3244-8
[23]
Rodriguez, J.A. and Rathod, P.A. (2012) Large Diameter Heads. Bone & Joint Journal, 94, 52-54. https://doi.org/10.1302/0301-620X.94B11.30508
[24]
Singh, S., Kumar, S., Rohilla, S. and Maini, L. (2014) Functional Anthropometric Measurements of Indian Pelvis. Journal of Clinical Orthopaedics and Trauma, 5, 79-83. https://doi.org/10.1016/j.jcot.2014.05.001
[25]
Evangelista, P.J., Kamath, A.F., Aversano, F.J., Silvestre, J., Lee, G.C. and Nelson, C.L. (2015) Ceram-ic-Ceramic Hip Arthroplasty for Osteonecrosis: Average 5-Year Follow-up in Patients Less than 50 Years of Age. Bulletin of the Hospital for Joint Disease, 73, 42-45.
[26]
Australian Orthopaedic Association (2013) National Joint Replacement Registry. Annual Report. AOA, Adelaide.
[27]
Wan, G., Sun, J., Zha, G., Zhao, X., Wang, T., You, Z., et al. (2015) Mid- and Long-Term Effectiveness of Third-Generation Ceramic-on-Ceramic Total Hip Arthroplasty in Younger Patients. Chinese Journal of Reparative and Reconstructive Surgery, 29, 1057-1061.
[28]
Schroder, D., Bornstein, L., Bostrom, M.P., Nestor, B.J., Padgett, D.E. and Westrich, G.H. (2011) Ceramic-on-Ceramic Total Hip Arthroplasty: Incidence of Instability and Noise. Clinical Orthopaedics and Related Research, 469, 437-442. https://doi.org/10.1007/s11999-010-1574-3
[29]
Galloa, J., Goodmanb, S.B., Lostaka, J. and Janout, M. (2012) Advantages and Disadvantages of Ceramic on Ceramic Total Hip Arthroplasty: A Review. Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, 156, 204-212. https://doi.org/10.5507/bp.2012.063
[30]
Jeffers, J.R.T. and Walter, W.L. (2012) Ceramic-on-Ceramic Bearings in Hip Arthroplasty: State of the Art and the Future. The Journal of Bone and Joint Surgery, 94, 735-745. https://doi.org/10.1302/0301-620X.94B6.28801
[31]
Gallo, J., et al. (2012) Advantages and Disadvantages of Ceramic on Ceramic Total Hip Arthroplasty: A Review. Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, 156, 204-212. https://doi.org/10.5507/bp.2012.063
[32]
Walter, W.L., O’toole, G.C., Walter, W.K., Ellis, A. and Zicat, B.A. (2007) Squeaking in Ceramic-on-Ceramic Hips: The Importance of Acetabular Component Orientation. The Journal of Arthroplasty, 22, 496-503. https://doi.org/10.1016/j.arth.2006.06.018
[33]
Owen, D., Russell, N., Chia, A. and Thomas, M. (2014) The Natural History of Ceramic-on-Ceramic Prosthetic Hip Squeak and Its Impact on Patients. European Journal of Orthopaedic Surgery & Traumatology, 24, 57-61. https://doi.org/10.1007/s00590-012-1142-5
[34]
Lusty, P.J., Tai, C.C., Sew-Hoy, R.P., Walter, W.L., Walter, W.K. and Zicat, B.A. (2007) Third-Generation Alumina-on-Alumina Ceramic Bearings in Cementless Total Hip Arthroplasty. The Journal of Bone and Joint Surgery, 89, 2676-2683. https://doi.org/10.2106/JBJS.F.01466
[35]
Mai, K., Verioti, C., Ezzet, K.A., Copp, S.N., Walker, R.H. and Colwell, C.W. (2010) Incidence of “Squeaking” after Ceramic-on-Ceramic Total Hip Arthroplasty. Clinical Orthopaedics and Related Research, 468, 413-417. https://doi.org/10.1007/s11999-009-1083-4
[36]
Spears, I.R., Pfleiderer, M., Schneider, E., Hille, E., Bergmann, G. and Morlock, M.M. (2000) Interfacial Conditions between a Press-Fit Acetabular Cup and Bone during Daily Activities: Implications for Achieving Bone In-Growth. Journal of Biomechanics, 33, 1471-1477. https://doi.org/10.1016/S0021-9290(00)00096-8
[37]
Yoo, J.J., Kim, Y.M., Yoon, K.S., Koo, K.H., Kim, J.W., Nam, K.W. and Kim, H.J. (2006) Contemporary Alumina on Alumina Total Hip Replacement. Journal of Biomedical Materials Research Part B: Applied Biomaterials, 78B, 70-75. https://doi.org/10.1002/jbm.b.30457
[38]
Baek, S.H. and Kim, S.Y. (2008) Cementless Total Hip Replacement with Alumina Bearings in Patients Younger than Fifty with Femoral Head Osteonecrosis. The Journal of Bone and Joint Surgery, 90, 1314-1320. https://doi.org/10.2106/JBJS.G.00755
