Cadera/Hip/Hüfte/Hanche: Cerámica contra polietileno: ¿combinación aceptable?

The case for ceramic-on-polyethylene as the preferred bearing for a young adult hip replacement

David J.W. Cash, Vikas Khanduja

Hip Int 2014; 24(5): 421 - 427

Article Type: REVIEW

Abstract

The optimum choice of bearing surfaces in total hip arthroplasty, particularly in the younger and more active patient, remains controversial. Despite several studies demonstrating good long-term results for the metal-on-polyethylene articulation, there has been a recent vogue towards the utilisation of hard-on-hard bearings for younger patients due, in part, to concerns regarding polyethylene induced osteolysis. However, well-documented complications concerning metal-on-metal bearings and the risk of fracture in ceramic-on-ceramic bearings have raised concerns regarding the principle of the hard-on-hard bearing in the active patient. With recent technological advancements in the manufacture of both polyethylene and alumina ceramics, the in vitro properties of each material with regards to strength and toughness have been significantly improved. In addition, ceramic femoral heads have consistently been shown to produce less in vivo polyethylene wear than similar sized metal heads. This paper aims to critically review the biomechanical, in vivo and clinical studies related to the use of the ceramic on polyethylene bearing, and highlights its potential use as the preferred bearing for a young adult hip replacement.

Rodilla/Knee/Knie/Genou: 30 años después de la PTR

Total Knee Replacement in Young, Active Patients: Long-Term Follow-up and Functional Outcome: A Concise Follow-up of a Previous Report
Long, W. J., Bryce, C. D., Hollenbeak, C. S., Benner, R. W., Scott, W. N.
The Journal of Bone & Joint Surgery, 17 Septiembre 2014 19:30

Abstract:

Concern exists regarding the long-term durability and effectiveness of total knee arthroplasty in young patients.

We reviewed our experience with total knee arthroplasty in patients fifty-five years old and younger with severe osteoarthritis to determine the long-term outcomes. One hundred and fourteen total knee arthroplasties were performed in eighty-eight patients at an average patient age of fifty-one years. Clinical outcomes, survival analysis, and radiographs were all reviewed at the most recent follow-up. One hundred and eight knees (eighty-four patients) were followed up from May 2011 to 2012.

At thirty years, survivorship without revision for any cause was 70.1% (twenty-five revisions) and survivorship with failure defined as aseptic revision of the tibial or femoral components was 82.5%. At thirty years, a significant difference existed in the survivorship free from tibial or femoral aseptic revision (p = 0.003) between the non-modular Insall-Burstein I component (92.3%) and the modular Insall-Burstein II component (68.3%). All patients were evaluated at an average time from the index total knee arthroplasty to the latest follow-up of 25.1 years (range, twenty to thirty-five years). Clinical evaluation was obtained in thirty-six patients with forty-five total knee arthroplasties. The average Hospital for Special Surgery score had improved from 57.9 points preoperatively to 85.3 points. The average Knee Society score was 87.4 points and the average Knee Society functional score was 62.1 points; the average knee motion was 110°. The mean Tegner and Lysholm activity score improved from 1.5 points preoperatively to 3.0 points. Radiographic review of forty-two knees that had undergone total knee arthroplasty demonstrated a mean 3.2° of valgus, with no cases of radiographically loose components.

Total knee arthroplasty with use of a cemented posterior stabilized system, particularly a non-modular Insall-Burstein I design, was an effective treatment option with durable results for end-stage symptomatic osteoarthritis in this young cohort. These data should provide comparison for modern total knee arthroplasties and alternative procedures in young patients.

Level of Evidence:
Therapeutic Level IV