Fractures of a sandwich ceramic liner at ten year follow-up.
OBJECTIVE
The aim of this study was to understand the causes of sandwich liner fractures implanted at our institution by evaluating the long-term results of this device.


METHODS
We retrospectively assessed 143 patients (151 hips) consecutively operated upon in our department by the same senior surgeon between 1999 and 2001 and with a mean follow-up period of 9.9 years (range 8.5-11.5). The components used were Cerasul® sandwich ceramic liners within a cementless cup. Patient assessment was based on demographic factors (age, gender, body mass index), the clinical scores according to Devane (activity), the potential complications and a radiographic analysis from an anteroposterior pelvic radiograph (cup inclination). Revision cases and their cause were classified (implant fracture, loosening, dislocation, periprosthetic fracture).


RESULTS
Five cases of liner fracture (3.7%) were observed at a mean seven year (4.5-8.5) follow-up. The risk factor for implant failure was found to be patient activity: the mean preoperative Devane score was 3.5 in the fracture group vs 2.6 in the control group (p = 0.008). Mean cup inclination was 52°. The survivorship analysis at ten years was 85% with revision as the endpoint. Prosthetic complications accounted for 8.6% of all 151 hips (fractures included): one case of aseptic loosening (0.7%), two cases of sepsis (1.4%), four cases of isolated dislocation (2.8%) and one case of recurrent dislocation (0.7%).


CONCLUSIONS
Alumina sandwich liners remain a subject of concern since the increasing clinical follow-up period may predispose them to fatigue failure. This system has been abandoned in our department since 2005.
Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Chirurgie Orthopédique, Traumatologique et Médecine du Sport, Lyon, France. anthony.viste@chu-lyon.fr
Anthony
A
Viste
Julien
J
Chouteau
Romain
R
Desmarchelier
Michel-Henri
MH
Fessy
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D002516:Ceramics; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures; D011475:Prosthesis Failure; D011859:Radiography; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult