Ceramics in Orthopaedics

Ceramics in Orthopaedics

Edited by

FRANCESCO BENAZZO

FRANCESCO FALEZ

MARTIN DIETRICH

11

^th

BIOLOX

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Symposium

Proceedings

Ceramics in Orthopaedics

FRANCESCO BENAZZO FRANCESCO FALEZ MARTIN DIETRICH Editors

11

^th

BIOLOX

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Symposium Rome, June 30 - July 1, 2006 Proceedings

with 177 Figures in 206 separate Illustrations and 40 Tables

Bioceramics and Alternative

Bearings in Joint Arthroplasty

ISBN 3-7985-1634-0 Steinkopff Verlag, Darmstadt

Cataloging-in-Publication Data applied for

A catalog record for this book is available from the Library of Congress.

Bibliographic information published by Die Deutsche Bibliothek

Die Deutsche Bibliothek lists this publication in the Deutsche Nationalbibliografie, detailed bibliographic data is available in the Internet at <http://dnb.ddb.de>.

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Steinkopff Verlag. Violations are liable for prosecution under the German Copyright Law.

Steinkopff Verlag Darmstadt

a member of Springer Science+Business Media http://www.steinkopff.springer.de

© Steinkopff Verlag, Darmstadt, 2006

© Printed in Germany

The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Product liability: the publishers cannot guarantee the accuracy of any information about the application of operative techniques and medication contained in this book. In every individual case the user must check such information by consulting the relevant literature.

Cover Design: TOP DESIGN, Thomas Schuster, Waiblingen

Production and Typesetting: druckerei justus kuch GmbH, Nürnberg

SPIN 11779575 105/7231-5 4 3 2 1 0 - Printed on acid-free paper.

FRANCESCO BENAZZO, Prof. Dr.

Università di Pavia Clinica Ortopedica Via Taramelli, 3

27100 Pavia, Italy

FRANCESCO FALEZ, Prof. Dr.

Ospedale S. Spirito Div. Ortopedia Lungotevere in Sassia, 3

00193 Roma, Italy MARTIN DIETRICH, Dr.

CeramTec AG Fabrikstr. 23-29

73207 Plochingen, Germany

Dear Colleague and Participant in Bioceramics and Alternative Bearings in Joint Arthroplasty: 11

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International BIOLOX

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Symposium

We are once again very proud of the fact that we have been able to provide you with the proceedings of this Symposium as a part of your registration materials. This is a mayor achievement that could only be made possible by the excellent cooperation of all of the speakers, the publishing house and their staff and the Symposium Administrator and her support staff. Our special thanks to all of them for their hard work and dedication to meet the difficult deadlines required to make this a reality.

The proceedings for this Symposium continue the on-going tradition to provide all of us with a valuable and useful addition to our reference library. We hope that within its covers, you will find the most up to date scientific and clinical information regarding the use of ceramic solutions to address wear related problems in Orthopedic Surgery.

This is the first time that the symposium takes place in Italy. The reason we chose Italy and in particular Rome is obvious as CeramTec has had a long term and close relationship with the Italian. CeramTec is pleased that our Symposium Chairmen, Professors F. Benazzo and F. Falez have collaborated with us in the preparation and in the execution of Bioceramics and Alternative Bearings in Joint Arthroplasty - 11

^th

International BIOLOX

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Symposium.

We hope that the quality of the presentations, the openness of the discussions, the efficiency of the organization, the knowledgeable participants and the City of Rome will have all worked together to make this a very special event in the pursuit of increased recognition of the benefits of our BIOLOX

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ceramic technology by the Global Orthopedic Surgical community.

Prof. Dr. F. Benazzo Prof. Dr. F. Falez Dr. M. Dietrich Symposium President Symposium President Managing Director

CeramTec Medical Products

Preface

In memoriam

Prof. Dr. rer. nat. Gerd Willmann

The bioceramics world mourns the loss of Professor Willmann.

On July 3

^rd

2005, the distinguished professor and former member of the CeramTec Medical Products Division passed away following a short and severe illness.

An internationally recognized researcher, Dr. Willmann’s bioceramic and orthopedic implant research greatly contributed to the recognition of alumina ceramics as the ideal wear reduction solution for the young and active patient needs for increased durability from his joint replacement.

His extensive publications and presentations are well known to scientists and orthopedic surgeons all over the world. In our opinion, Dr. Willmann’s greatest contribution to the field has been the creation of this international recognized medium of exchange of the latest information on the use of ceramics and alternative bearings to the orthopaedic surgical community.

His dedication and genius will continue to be felt in the countless footsteps

that might never have been taken. Or in the natural act of holding this book

or picking a flower. In these simple ways the world will silently remember this

extraordinary man.

Large diameter femoral and acetabular components

1.1 Head Diameter of 36mm:

New alumina on alumina bearing surfaces ...3

A. Berizzi, M. Tzemtzang and R. Aldegheri

1.2 All ceramic tripolar Total Hip Arthroplasty:

experimental data and clinical results ...5

J.-Y. Lazennec, H. Sari Ali, M. A. Rousseau and S. Hansen

1.3 Clinical advantages with large diameter heads ...11

N. Santori, R. Giacomi, D. Potestio and F. Chilelli

1.4 36mm Ceramic head for ”difficult” cases ...17

G. P. Rinaldi, M. Bonalumi, D. Gaietta and D. Capitani

Resurfacing in total hip replacement

2.1 Seven years of experience in MoM resurfacing:

Results and open questions ...23

M. Menge

2.2 Surgeon and resurfacing:

considerations after a long experience ...31

F. Ravasi and P. Sirtori

2.3 Hip Resurfacing – a superior articulation concept? ...39

R. M. Streicher

2.4 Consideration on disadvantages

and problems of resurfacing ...45

L. Massari, G. Caruso and V. Sollazzo

2.5 In vitro biomechanical properties

of a hip resurfacing system ...47

P. F. Indelli, N. Veins, D. Dominguez, K. Kitaoka and T. Parker Vail

2.6 Comparison of functional activity of hip resurfacing

with total hip arthroplasty ...51

J. D. Witt, V. Kannan and T. White

List of contents

SESSION 1

SESSION 2

X

Hard-hard bearing systems

3.1 Radiological development of an alumina metal

back cup during 5 years ...55

J. Bejui-Hugues, H. Chavane, V. Pibarot, J. M. Durand, G. Vaz,

O. Guyen, A. Richard and J. P. Carret

3.2 Metal Ion Hypersensitivity in Metal-on-Metal

Hip Arthroplasty ...57

Y.-S. Park, Y.-W. Moon and S.-J. Lim

3.3 28mm Head in Ceramic/Ceramic Total Hip Replacement ...65

M. Marcucci, P. Aglietti, P. Poli and L. Latella

3.4 Ceramic Bearings Enlarging the Range

of Indications for Bipolar Prostheses ...73

A. Olk, T. Bartscher, J. Gusinde and F. F. Hennig

3.5 Kinematic evaluation of total hip arthroplasty

with various bearing materials ...81

D. A. Dennis, R. D. Komistek and M. R. Mahfouz

3.6 Total hip replacement with all alumina bearings

in patients under 30 years of age ...93

G. Biette, R. S. Nizard, P. Bizot, F. Lemonne and L. Sedel

Ceramic knee

4.1 PE wear in ceramic/PE bearing surface in total knee arthroplasty:

Clinical experiences of more than 24 years ...101

H. Oonishi, S. C. Kim, M. Kyomoto, M. Iwamoto and M. Ueno

4.2 Hypersensitivity reactions in association to arthroplasty ...111

M. Thomsen and P. Thomas

4.3 Ceramic Knee Design ...115

P. Dalla Pria, L. Giorgini, M. Kuntz and T. Pandorf

4.4 Ceramic knee endoprostheses: reality or future? ...125

W. Mittelmeier, S. Ansorge, D. Klüß, J. Kircher and R. Bader

Hip Revision

5.1 Comparison of clinical results between Ceramic-Ceramic Bearings and Metal on Polyethylene in Total Hip Arthroplasty ...135

J. P. Garino and B. Vannozzi

SESSION 3

SESSION 4

SESSION 5

XI

5.2 Revision strategy after metal on metal THR failure:

Conversion to ceramic on ceramic ...141

Y. Catonné, J.-Y. Lazennec, A. Nogier, E. Fourniols and B. Masson

5.3 Modular neck and ceramic on ceramic coupling

in revision total hip arthroplasty ...145

G. Pignatti, C. Stagni, D. Dallari, V. Bochicchio, A. Raimondi and A. Giunti

5.4 Experience with BIOLOX

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option revision heads ...149

T. Güttler

5.5 Acetabular cup revision: pitfalls and solutions ...155

W. Mittelmeier, M. Haenle, J. Kircher, R. Bader and M. Hauschild

5.6 Revision strategies in total hip arthroplasty

with respect to articulation materials ...163

K. Knahr and M. Pospischill

Tribology

6.1 Hip Joint Simulators: State of the Art ...171

S. Affatato, W. Leardini and M. Zavalloni

6.2 Highly Crosslinked Ultra High Molecular Weight Polyethylene-(UHMWPE-) Acetabular Liners

in combination with 28mm BIOLOX

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heads ...181

C. Hendrich, N. Wollmerstedt, A. Ince, F. Mahlmeister, S. Göbel and U. Nöth

6.3 Wear of Highly Crosslinked Polyethylene against

Cobalt Chrome and Ceramic femoral heads ...185

J. Fisher, L. M. Jennings and A. L. Galvin

6.4 US perspective on hip simulator wear testing of

BIOLOX

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delta in ‘severe’ test modes ...189

I. C. Clarke, D. Green, P. Williams, T. Donaldson and G. Pezzotti

6.5 Comparison of polythene liners with alumina

liners in hydroxyapatite hip arthroplasty ...207

J. M. Buchanan

6.6 Edge Loading and Squeaking in Third Generation

Ceramic-on-ceramic Bearings ...213

W. L. Walter, W. K. Walter and M. A. Tuke

Tricks and tips: how to manage the implantation of ceramic implants

7.1 Tricks and tips in every day utilization of ceramic

on ceramic coupling ...219

R. Giacometti Ceroni, L. Zagra and M. Corbella

SESSION 6

SESSION 7

XII

7.2 Neck Modularity and CE/CE systems ...225

P. Gaffurini and S. Bertoglio

7.3 Off-set and ceramic on ceramic bearing ...233

A. Toni, F. Traina, A. Cervinini, M. De Fine and B. Bordini

7.4 Ceramic on ceramic cementless total hip rthroplasty in arthritis following congenital hip

disease: an algorithm of the surgical treatment ...237

R. Binazzi, A. Bondi, A. Manca, L. Marchesini and M. Delcogliano

7.5 32mm alumina on alumina hip replacement

for femoral neck fracture ...243

G. Solarino, A. Piazzolla, N. Tartaglia, L. Scialpi and G. B. Solarino

7.6 Is there really a ”safe zone” for the placement

of total hip components? ...249

K.-H. Widmer

7.7 Tips of the trade: avoiding problems with

ceramic components in THR ...253

J. P. Garino

Future Applications

8.1 Direct to bone – possible ceramic solutions

for monolithic hip implants ...259

R. Burgkart, E. Steinhauser, M. Grässel and M. Kuntz

8.2 Surface Activation of Implants ...263

H. Mannel, D. Zukowski, A. Sewing and V. Alt

8.3 Application of Bone Morphogenic Proteins on Solid Implants ...277

J. A. Mollenhauer, K. D. Jandt and P. Hortschansky

8.4 Future applications in ceramics ...283

P. Merkert and M. Kuntz

1. The use of a ceramic ”sandwich cup” in 140

hip arthroplasty with a 5 years follow-up or more ...291

M. P. Philippe, J. Hummer, T. Musset, P. Poilbout and C. Schwartz

2. THR Charnley type with Zr/Pe Bearing results

at more than 5 years FU ...293

J. H. Caton

3. Wear Performance of Carbon Fibre Reinforced Implantable

PEEK against BIOLOX

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Forte and BIOLOX

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Delta ...295

J. Devine, A. Unsworth and S. C. Scholes

SESSION 8

POSTER

XIII

4. Big diameter ball heads on Corail Stem:

Rational indication and advantages ...297

S. Ghera

5.

A

The Role of Pre-Irradation Crystallinity on the

Oxidation Resistance of UHMWPE ...299

F. D’Angelo, A. Ferretti, T.S. Thornhill and A. Bellare

5.

B

The Effect of Pressure-Annealing on the Oxidation

Resistance of Irradiated UHMWPE ...303

F. D’Angelo, F. Conteduca, T. S. Thornhill and A. Bellare

6. Clinical results of zirconia PE bearings

G. Maccauro

7.

A

Outcome of 100 consecutive ceramic on ceramic total hip arthroplasties performed by one surgeon

G. Solarino

7.

B

Results of ceramic on ceramic total hip arthroplasty in avascular necrosis of the femoral head

G. Solarino

8. Wear Simulator Study of the Tripolar All Ceramic

Hip Prosthesis ...307

L. M. Jennings, J. Fisher, T. D. Stewart, B. Masson and J. Y. Lazennec

9. Metallic but not ceramic wear particles increase prostaglandin E

2

release and interleukin-1β (IL-1β)

gene expression in human blood monocytes in vitro ...309

G. Falcone, M. Galli, C. Toriani Terenzi, A. Pozzetto, G. Tringali, V. De Santis,

M. Vairano, P. Navarra and G. Pozzoli

10. BMP-2 modified ingrowth characteristics of coated hydroxyapatite-titanium implants

in aged sheep ...313

A. Sachse

11. Ultimate Compression Strength Testing of

Alumina Ceramic Femoral Heads in Revision ...317

N. G. Dong, P. F. Sharkey, M. A. Kester and A. Wang

12. BIOLOX

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option: A new revision strategy

with BIOLOX

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ceramics ...319

B. Masson

13. Duolox

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, a ceramic Bipolar System

for Hemiarthroplasty ...321

B. Masson

SAVERIO AFFATATO, Dr.

Ist. Rizzoli Bologna Lab Tec Medica Via di Barbiano, 1/10

40136 Bologna, Italy

JACQUES BEJUI-HUGUES, Dr.

Centre Hospitalier de Lyon Hôpital Edouard Herriot Pavillon T

Place d'Arsonval 69003 Lyon, France

FRANCESCO BENAZZO, Prof. Dr.

Università di Pavia Clinica Ortopedica Via Taramelli, 3

27100 Pavia, Italy

ANTONIO BERIZZI, Dr.

Clinica Ortopedica Universita di Padova Via Giustiniani, 3

35128 Padova, Italy

GREGORY BIETTE, Dr.

Groupe Hospitalier La Pitié Salpetrière Service Orthopédie et traumatologie Pav Gaston Cordier

47/83 bd de l'Hôpital 75013 Paris, France

ROBERTO BINAZZI, Prof. Dr.

Ist. Rizzoli Bologna Via G.C. Pupilli, 1 40136 Bologna, Italy

JAMES M. BUCHANAN, FRCS Sunderland Royal Hospital 13 Westfield Avenue Gosforth Newcastle Upon Tyne

Tyne Wear NE3 4YH, United Kingdom

RAINER BURGKART, Dr.

Technische Universität München Klinik für Orthopädie und Sporthorthopädie Ismaringer Str. 22

81675 München, Germany

YVES CATONNÉ, Prof.

Groupe Hospitalier La Pitié Salpetrière Pav Gaston Cordier

47/83 bd de l'Hôpital 75013 Paris, France

IAN C. CLARKE, PhD

Loma Linda University Medical Center Peterson Tribology Lab.

Dept. of Orthopaedics 12340 Anderson St.

Loma Linda Ca 92350, USA

PAOLO DALLA PRIA, Ing.

Lima Lto spa Via Nazionale

33038 Villanova (UD), Italy

DOUGLAS A. DENNIS, Dr.

7250 South Polo Ridge Drive Littleton, Colorado, 80128, USA

FRANCESCO FALEZ, Prof. Dr.

Ospedale S. Spirito Div. Ortopedia Lungotevere in Sassia, 3

00193 Roma, Italy

JOHN FISHER, Prof.

School of Mechanical Engineering University of Leeds Institute of Medical

and Biological Engineering West Yorkshire

LS2 9JT Leeds, United Kingdom

PAOLO GAFFURINI, Dr.

ARS Medica Clinic Via Cantonale

6929 Gravesano - Lugano, Switzerland

JONATHAN P. GARINO, Dr.

Associate Professor Department of Orthopedic Surgery,

Cupp building first floor University of Pennsylvania 51 North 39th Street Philadelphia, PA 19104, USA

XV

List of podium presenters and chairmen

XVI

ROBERTO GIACOMETTI CERONI, Prof. Dr.

Istituto Ortopedico Galeazzi 4 Via R. Galeazzi, 4

85112 Milano, Italy

THOMAS GÜTTLER Aesculap

Am Aesculap Platz 78532 Tuttlingen, Germany

CHRISTIAN HENDRICH, Prof. Dr.

Orthopädisches Krankenhaus Schloss Werneck

Balthasar-Neumann-Platz 1 97440 Werneck, Germany

PIER FRANCESCO INDELLI, MD Duke University Medical Center Department of Orthopaedic Surgery DUMC Box 2923

Durham North Carolina 27710, USA

KARL KNAHR, Prof. Dr.

Orthopädisches Spital Speising GmbH Speisinger Str. 109

1130 Wien, Austria

RENATO LAFORGIA, Dr.

Ospedale di Matera Via Garruba, 3 70122 Bari, Italy

JEAN-YVES LAZENNEC, Prof.

Groupe Hospitalier La Pitié Salpetrière Pav Gaston Cordier

47/83 bd de l'Hôpital 75013 Paris, France

HENRICH MANNEL, Dr.

BIOMET Deutschland GmbH Gustav-Krone-Str. 2

4167 Berlin, Germany

MASSIMILIANO MARCUCCI, Prof. Dr.

C.T.O. Firenze Largo Palagi, 2 50139 Firenze, Italy

LEO MASSARI, Prof. Dr.

Arcispedale S. Anna Corso Giovecca, 203 44100 Ferrara, Italy

ALESSANDRO MASSÉ, Prof. Dr.

C.T.O. Torino Via Zuretti, 29 10126 Torino, Italy

PATRICIE MERKERT, Dr.

CeramTec Medical Products Fabrikstr. 23-29

73207 Plochingen, Germany

MICHAEL MENGE, Prof. Dr.

St- Marienkrankenhaus - Orthopädische Abteilung Salzburger Str. 15

67067 Ludwigshafen, Germany

MARIO MERCURI, Prof. Dr.

Istituti Ortopedici Rizzoli Via G.C. Pupilli, 1 40136 Bologna, Italy

WOLFRAM MITTELMEIER, Prof. Dr.

Komm. Direktor der Klinik und Poliklinik für Orthopädie, Universität Rostock Ulmenstr. 44/45

18055 Rostock, Germany

JÜRGEN A. MOLLENHAUER, Prof. Dr. Dr.

Klinik für Orthopädie der Universität Jena Am Waldkrankenhaus "Rudolf Elle" Eisenberg Klosterlausnitzer Str. 81

07607 Eisenberg, Germany

ALEXANDER OLK, Dr.

Universitätsklinikum der Universität Erlangen-Nürnberg

Krankenhausstr. 12 91054 Erlangen, Germany HINOROBU OONISHI, MD PhD

H. Oonishi Memorial Joint Replacement Institute 4-48

1-4-48, Minato-Machi

Naniwa-Ku Osaka-Shi 556-0017, Japan

YOUN-SOO PARK, MD PhD Dept. of Orthopedic Surgery Samsung Medical Center 50, Ilwon dong, Kangnam gu, Seoul 135-710, South Korea

CORRADO PICONI, Prof.

Via Pasquale II, 240 00168 Roma, Italy

GIOVANNI PIGNATTI, Dr.

Istituti Ortopedici Rizzoli Via G.C. Pupilli, 1 40136 Bologna, Italy

GERALD PFLÜGER, Prof. Dr.

Evangelisches Krankenhaus Wien Hans Sachs Gasse 10 - 12 1180 Wien, Austria

FLAVIO RAVASI, Dr.

Ospedale di Melzo Via Maffia, 6 20066 Melzo, Italy

GIAMPAOLO RINALDI, Dr.

Via Losanne, 18 20154 Milano, Italy

CARLO RUOSI, Prof.

Univ. Di Napoli - Clinica Ortopedica Via Tito Livio, 9

80122 Napoli, Italy

NICOLA SANTORI, Dr.

Centro Diagnostico Via Pigafetta, 1 00154 Roma, Italy

LAURENT SEDEL, Prof.

Hôpital Lariboisière - Service d'Orthopédie 2, rue Ambroise Paré 75010 Paris, France

GIUSEPPE SOLARINO, Dr.

Clinica Ortopedica 1, Università degli Studi di Bari Piazza Giulio Cesare, 11 70124 Bari, Italy

ROBERT M. STREICHER Stryker SA

Florastrasse 13

8800 Thalwil, Switzerland

PETER THOMAS, Dr.

Klinik und Poliklinik für Dermatologie und Allergologie der

Ludwig-Maximilians-Universität München Frauenlobstr. 9-11

80337 München, Germany

MARC THOMSEN, Priv.-Doz. Dr.

Orthopädische Universitätsklinik Heidelberg

Schlierbacher Landstr. 200a 69118 Heidelberg, Germany

ALDO TONI, Dr.

Istituto Ortopedico Rizzoli Laboratorio dei Materiali Via Di. Barbiano, 1/10 40136 Bologna, Italy

ENRICO VAIENTI, Prof.

Azienda Ospedaliera Parma Clin. Ortop.

Via Gramsci, 14 43100 Parma, Italy

WILLIAM L. WALTER, MD Sydney Hip & Knee Surgeons Level 3, 100 Bay Road

Waverton N.S.W. 2060 Sydney, Australia

KARL-HEINZ WIDMER, Dr.

Kantonsspital Schaffhausen Geissbergstrasse 81

8208 Schaffhausen, Switzerland

JOHAN WITT, FRCS

Consultant Orthopaedic Surgeon University College Hospitals London 110 Sutherland Avenue, Maida Vale London W92QP, United Kingdom

XVII