TITLE:
Restoring Natural Hip Movements with Large Head (Ceramic on Ceramic) Total Hip Replacement: Experience of Our 150 Patients over 6 Years
AUTHORS:
Sanjay Agarwala, Mayank Vijayvargiya, Sameer Chaudhari
KEYWORDS:
Ceramic-on-Ceramic, Total Hip Arthroplasty, Squeaking, Prosthesis Survivorship, Harris Hip Score
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.7 No.12,
December
5,
2017
ABSTRACT: Background: Asian cultures require floor-seated positions demanding a high range of motion
(ROM). Ceramic-On-Ceramic (COC) interface allowed the use of larger head with reduced
wear debris generation and adverse tissue reactions. This study was conducted to
analyze 6-year clinical-radiological outcome with large head fourth generation DeltaMotion® ceramic-on-ceramic (COC) hip articulation, with special
emphasis on postoperative ROM, ability to sit cross-legged, stability, hip noise
and revision surgery. Material and Methods: 150 consecutive hips were operated
for primary cementless Total Hip Replacement (THR) using DeltaMotion® at a tertiary care center in Mumbai, India, between
January 2010 and January 2015. Clinico-radiological outcome was assessed using the
Harris Hip Score (HHS) and radiographs at 6 weeks, 6 months, and annually thereafter. Results: 108 (74.5%) patients were males and 37 (25.5%) were females with
an average age of 50.87 years. Mean follow-up was 54
months (range: 37 - 86 months).
The mean ROM was 120° in flexion, 10° in extension, 30° in adduction, 45° in abduction,
25° in internal rotation and 25° in external rotation. The mean HHS showed a statistically
significant improvement of 64.5% (from 54.66 ± 6.42 pre-operatively to 89.95 ± 4.32
post operatively) (p-value: 0.001). 92% of patients were able to sit in squatting
position and 92% were able to sit cross-legged on the floor at last follow-up. 0.7% joints (1 hip) had squeaking. Considering no
revision surgery as the end point, 6-year prosthesis survivorship was 100%. Complications
(superficial infection) occurred in three hips (2%). All patients reported to be satisfied with their outcome after surgery. Conclusion: We infer that DeltaMotion large head COC bearing allows scope for using larger
head size in relatively smaller Indian hips due to factory fitted ceramic lining.
At 6-year follow-up, high activity level was observed with excellent clinical-radiological
outcomes and component longevity in relatively young Indian population.