Abstract
Introduction
The ceramic-on-ceramic strategy in acetabular revision faces potential limitations due to the femoral stem, as the implantation of ceramic ball head on a previously used taper is not recommended. Delta (r) ball heads with titanium sleeves have been proposed to avoid femoral revision. The study reports a minimum 3 years follow-up experience using this strategy.
Materials and Methods
This series report 42 revisions (16 metal-on-metal and 26 PE THA) in 39 patients (mean age 59.2 years, mean BMI 25). The 12-14, 5°46 sleeves were used in 24 cases and 10-12, 6° in 18 cases. (32mm ball head in 26 cases and 36 mm in 16 cases). Titanium serum level has been studied to detect the potential release from the sleeve-taper interface.
Results
We did not observe ceramic fracture or squeaking. Serum titanium levels remained under the detection limit .3 procedures failed:
- 2 hips in the same immunodeficient patient due to septic complications (secondary successful one stage revisions)
- 1 failure of cementless fixation
4 dislocations occurred (2 cases due to neurological deficiencies, 2 cases explained by the lack of offset of the previous stem). No revision was required.
Conclusion
The ceramic on ceramic strategy without femoral revision can be considered according to this study. Accurate informations on the taper details are required, as well as carefull peroperative inspection to exclude damaged stems. The dislocation risk is significant when the previous femoral implantation is suboptimal.
