Abstract
Objective: To point out the strict rules of surgical technique required for the success of newly applied advanced technology.
Materials: 73 hips in 70 patients, aged 23 to 71 years old, underwent total hip arthroplasty using ceramic bearing surfaces implants. 62 were a primary procedure, and 11 were revision surgery.
Results: One complication of fracture of posterior ace-tabular wall was registered in a patient with ankylosing spondylitis, four early dislocations that were reduced closed, and one case of late postoperative death in a cardiac high-risk patient. No other complications were recorded since the first operation in May 1999. All patients had remarkable pain relief, improved range of motion and improved function.
Discussion: The tribological properties of the ceramic articulating surfaces favors them as the preferred technology for future orthopaedic implants. By reducing wear to a minimum the choice of ceramics seems to be justified. The main concern is fragility versus toughness. We have formulated ten rules of proper surgical technique concerning: accurate fit of the components, accurate orientation of the components, stability of the joints, adequate tissue tension, caring for debris and prevention of metal transfer due to ceramic-metal touch.
Conclusions: While our clinical experience is still short term, it appears that applying a rigorous and uncompromising surgical technique with ceramic bearing surfaces is essential for the clinical success of this potent bio-material.
Based on our experience, our recommendations are that:
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Ceramic bearing surfaces T.H.A.-s should be performed in specialized centers.
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The use of 32 mm. heads should be considered in order to avoid dislocations.
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With 28 mm. heads, full profile cups should be considered.
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Conservative physical therapy and range of motion exercises for 6–12 weeks.
The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
