Effect of alumina femoral head on clinical results in cemented total hip arthroplasty: old versus current alumina.

BACKGROUND: The wear rate of polyethylene against alumina was demonstrated to be lower than against metal, and the results of early clinical studies of alumina-on-polyethylene combination were as good as expected, but the long-term results of alumina ceramic heads were not as good, as reported by several authors. The purpose of this study was to assess the clinical results over 10 years of cemented total hip arthroplasty (THA) with two types of alumina head: old and current alumina. METHODS: We compared the clinical results of these two types of alumina used for cemented THA. The first type was old alumina (containing 7% yttria), and 77 hips with a 28-mm head (group I) were included. The second type was current alumina (highly purified alumina), and 50 hips with a 26-mm head (group II) and 88 hips with a 22-mm head (group III) were included. The mean follow-up was 17 years 4 months in group I, 12 years 3 months in group II, and 10 years in group III. RESULTS: The Kaplan-Meier survival analysis, with revision for any reason as the endpoint, predicted 10-year survival rates of 90.8%, 100%, and 97.5% for groups I, II, and III, respectively. The survival curves differed significantly only between groups I and II. The probabilities of 10-year survival of the pros-theses with radiological loosening as the endpoint were 77.2%, 91.6%, and 96.5%, respectively. The survival curves showed significant differences only between groups II and III. CONCLUSIONS: The old alumina showed a higher wear rate and rougher surface on the femoral head than did the current alumina in our previous study. The clinical results also indicated superiority of current alumina over old alumina. The difference in the size of the femoral head (26 vs. 22 mm) did not affect the clinical results.

Phase stability after aging and its influence on pin-on-disk wear properties of Ce-TZP/Al2O3 nanocomposite and conventional Y-TZP.

Recently zirconia/alumina composites have been examined by many researchers as the new generation of bearing materials in total joint replacements. In this study, the phase stability of a Ce-TZP/Al(2)O(3) nanocomposite and conventional Y-TZP after aging, and its influence on wear resistance, were investigated. Very slight phase transformation was observed in both types of ceramics 18 months after the implantation of Ce-TZP/Al(2)O(3) or Y-TZP samples into rabbit tibiae. However, Y-TZP showed marked phase transformation (approximately 80%) after aging in an autoclave (121 degrees C) for 190 h or in physiological saline at 62 degrees C for 18 months, whereas the new composite remained almost resistant to degradation. According to the results of self-pairing pin-on-disk wear tests using ceramic specimens with or without autoclave aging, the wear factor was almost the same between Ce-TZP/Al(2)O(3) samples with and without aging (6.74 +/- 0.36 x 10(-8) and 6.04 +/- 0.95 x 10(-8) mm(3)/Nm, respectively). In contrast, although non-aged Y-TZP had the lowest wear factor (4.88 +/- 0.51 x 10(-8) mm(3)/Nm) of all specimens tested, aged Y-TZP showed 10-fold greater wear than nonaged Y-TZP. The present study suggests that Ce-TZP/Al(2)O(3) nanocomposite has much greater phase stability than Y-TZP, and that its wear properties are not influenced by aging.

Ce-TZP/Al2O3 nanocomposite as a bearing material in total joint replacement.

The objectives of this study were to investigate the biocompatibility, phase stability, and wear properties of a newly developed Ce-TZP/Al(2)O(3) nanocomposite, as compared to conventional ceramics, and to determine whether the new composite could be used as a bearing material in total joint prostheses. In tests of mechanical properties, this composite showed significantly higher toughness than conventional Y-TZP. For biocompatibility tests, cylindrical specimens of both the Ce-TZP/Al(2)O(3) nanocomposite and monolithic alumina were implanted into the paraspinal muscles of male Wistar rats. The tissue reactions were almost the same, and at 24 weeks after implantation, thin fibrous capsules with almost no inflammation were observed around both of them. There were no significant differences in membrane thickness between the two ceramics. After hydrothermal treatment in 121 degrees C vapor for 18 h, the new composite showed complete resistance to aging degradation, whereas Y-TZP showed a phase transformation of 25.3 vol% (initial 0.4%) to the monoclinic form. According to the results of pin-on-disk tests, the wear rates of Ce-TZP/Al(2)O(3) nanocomposite and alumina were 0.55 +/- 0.04 x 10(-7) and 2.12 +/- 0.37 x 10(-7)mm(3)/Nm, respectively. The results of this study suggest that the Ce-TZP/Al(2)O(3) nanocomposite is a promising alternative ceramic component for total joint replacement.