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A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture

BACKGROUND: Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has co...

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Autores principales: Lucchini, Stefano, Baleani, Massimiliano, Giardina, Federico, Martelli, Andrea, Castagnini, Francesco, Bordini, Barbara, Traina, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9164427/
https://www.ncbi.nlm.nih.gov/pubmed/35658905
http://dx.doi.org/10.1186/s13018-022-03190-6
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author Lucchini, Stefano
Baleani, Massimiliano
Giardina, Federico
Martelli, Andrea
Castagnini, Francesco
Bordini, Barbara
Traina, Francesco
author_facet Lucchini, Stefano
Baleani, Massimiliano
Giardina, Federico
Martelli, Andrea
Castagnini, Francesco
Bordini, Barbara
Traina, Francesco
author_sort Lucchini, Stefano
collection PubMed
description BACKGROUND: Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has contributed to the decrease in fracture rate, at least of the prosthetic head. However, the root cause behind these rare events is not fully understood. This study evaluated head fracture occurrence in a sizeable cohort of patients with fourth-generation ceramic-on-ceramic implants and described the circumstances reported by patients in the rare cases of head fracture. METHODS: The clinical survivorship of 29,495 hip prostheses, with fourth-generation ceramic bearings, was determined using data from a joint replacement registry. The average follow-up period was 5.2 years (range 0.1–15.6). Retrieval analysis was performed in one case for which the ceramic components were available. RESULTS: Clinical outcomes confirmed the extremely low fracture rate of fourth-generation ceramic heads: only two out of 29,495 heads fractured. The two fractures, both involving 36 mm heads, occurred without a concurrent or previous remarkable trauma. Considering the feature of the fractured head, a multi-stage crack growth mechanism has been hypothesized to occur following damage at the head–neck taper interface. CONCLUSIONS: Surgeons must continue to pay attention to the assembly of the femoral head: achieving a proper head seating on a clean taper is a prerequisite to decrease the risk of occurrence of any damage process within head–neck junction, which may cause high stress concentration at the contact surface, promoting crack nucleation and propagation even in toughened ceramics.
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spelling pubmed-91644272022-06-05 A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture Lucchini, Stefano Baleani, Massimiliano Giardina, Federico Martelli, Andrea Castagnini, Francesco Bordini, Barbara Traina, Francesco J Orthop Surg Res Research BACKGROUND: Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has contributed to the decrease in fracture rate, at least of the prosthetic head. However, the root cause behind these rare events is not fully understood. This study evaluated head fracture occurrence in a sizeable cohort of patients with fourth-generation ceramic-on-ceramic implants and described the circumstances reported by patients in the rare cases of head fracture. METHODS: The clinical survivorship of 29,495 hip prostheses, with fourth-generation ceramic bearings, was determined using data from a joint replacement registry. The average follow-up period was 5.2 years (range 0.1–15.6). Retrieval analysis was performed in one case for which the ceramic components were available. RESULTS: Clinical outcomes confirmed the extremely low fracture rate of fourth-generation ceramic heads: only two out of 29,495 heads fractured. The two fractures, both involving 36 mm heads, occurred without a concurrent or previous remarkable trauma. Considering the feature of the fractured head, a multi-stage crack growth mechanism has been hypothesized to occur following damage at the head–neck taper interface. CONCLUSIONS: Surgeons must continue to pay attention to the assembly of the femoral head: achieving a proper head seating on a clean taper is a prerequisite to decrease the risk of occurrence of any damage process within head–neck junction, which may cause high stress concentration at the contact surface, promoting crack nucleation and propagation even in toughened ceramics. BioMed Central 2022-06-03 /pmc/articles/PMC9164427/ /pubmed/35658905 http://dx.doi.org/10.1186/s13018-022-03190-6 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Lucchini, Stefano
Baleani, Massimiliano
Giardina, Federico
Martelli, Andrea
Castagnini, Francesco
Bordini, Barbara
Traina, Francesco
A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture
title A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture
title_full A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture
title_fullStr A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture
title_full_unstemmed A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture
title_short A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture
title_sort case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9164427/
https://www.ncbi.nlm.nih.gov/pubmed/35658905
http://dx.doi.org/10.1186/s13018-022-03190-6
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