Schön Klinik Neustadt, Lehrkrankenhaus der Uni S-H, Campus … · 2017-12-08 · © 2015 Schön...

Seite 1 © 2015 Schön Klinik

Clinical experience with more than 4.800 CoC

P. Dufek

Schön Klinik Neustadt, Lehrkrankenhaus

der Uni S-H, Campus Lübeck, Germany

Praha 2015


Stable fixation- cementless, new technics of cementing

Minimal wear of contact surfaces-

highly crosslinked PE, ceramics

Tribology, the basic investigation

Long term results of THR


Young oldies - baby boomer - problem of PE wear, ostelysis


0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

Me/PE20a

Ce/PE20a

Me/XPE10a

Ce/XPE5a

Me/Me15a

Ce/Ce15a

0.137

0.072

0.042

0.031

0.005 < 0.001

We

ar

Ra

te [

mm

/a]

Clinical Wear Rates

20a – observation for 20 years; benign reaction of ceramic

particles (PE – inflammatory, Me – toxic, allergic)


Corrosion: ceramic 10x less; no Co, Cr & Ni release

Co/Cr/Ni


Why I use ceramics

Discussion:

medical - economic management

Prices of the implants

Best alternative for the patients

in endoprosthetics must be used!!

Effectively lower cost, more profit, good for the patients!


Silony Medical Int.

own company for endoprothesis

MicroPort Profemur Preserve

BIOLOX®delta (CeramTec)-

use in our clinic since 2005


Ce/Ce 36-36 ....... 2.914

Ce/Ce 32-32 ....... 1.896

Combination CoP 32-32 …… n: 3.950

Ceramic-on-ceramic bearing surface

Inlay 36 - head 36

Inlay 32 - head 32 (acc. cup-size)

Material Orthopedics Neustadt

Jan 2005- April 2015

Combination CoC Biolox®delta ...... n: 4.810


Use of CoC Orthop/ Traumatology NEU since 2010

2010 4 354 358

2011 1 593 594

2012 6 747 753

2013 5 842 847

2014 3 973 976

2015 5 401 406

Total 24 3910 3.934

Year Traumatology Orthop


Advantage -

Good stability and ROM of the hip after dysplastic-arthrosis

CoC 36 mm


Complications

- Fractures - head & insert 1x

- chipping of the rim of insert 2x

- Subluxation of insert (implantation failure) 2x

- Squeaking - benign 7x

Head fracture - periop. status

Patient 140 kg, fell down the staircase

Problem S-ROM Cone


Follow-up

Range of motion ROM , dislocation

2002-2004 cup Duraloc, head 28 mm

2004- today cup PINNACLE, head 32 – 36 mm

Material, Method

Retrospective study of ROM of heads 28, 32 &

36 mm based on the medical report- discharge from

REHAB

Each group of 100 patients, btw. 50-70y

Statistics of luxation 6 months after operation acc.

to the med. reports from orth. colleagues in the praxis


ROM

head 36 mm 15 dg. more than head 32

and 20 dg. more than head 28

Luxation- 6 M after op/ pro y (ca. 1500 TEPs pro y)

Head 28 mm MoP 0,9 %

Head 32 mm MoP 0,17%

Head 32 mm CoC

Head 36 mm CoC till today no luxation

Best combination CoC

Follow-up

results


• 126c bilateral 32 mm

– CoC 6x significantly less dislocation (p < 0.001)

• Meta-analysis

– CoC has significantly decreased dislocation rate in comparison to MoP (1.2% versus 5.0%, p < 0.01)

Hernigou, 2013

Hu, 2015

Less dislocation with CoC


Revisions for Infection (500’749 pats)

Streicher, 2014

Seite 17 © 2015 Schön Klinik ©

CoC in Early Infection therapy with PE

2005-2014 n:47 cases

Prospective study- 2 recidive cases

OP revision

Debridement of the joint

Exchange of PE liner to Cer insert mit Delta Option

Head , in the case of C/C comb. Only debridement

Lavage with antiseptics

Local application of GENTA- COLL resorb

Antibiotics therapy till CRP normalisation

Best solution for the infection-revision?

More studies necessary !


One week after THR with CoC & fast track rehabilitation


Discussion C on C (delta)

- Negligible wear, benign particles

- No influence of head size on wear

- No corrosion and metal release (Co, Cr, Ni)

- Only 1 head breakage (0,011%; forte 0,1%) - Fracture rate: austral. register delta = 0.0017% (all)

- Low incidence of rumors - benign

- Lower incidence of PJI

- Lower dislocation risk

- Low revision rate even at long-term

Take home message

Biolox®delta articulation with a ceramic head of 32 and 36mm

are very stabile, have a better range of motion and the risk of

long-term wear is basically zero compared to other

articulations


Thank you and you are welcome in Neustadt in Holstein

Schön Klinik Neustadt, Lehrkrankenhaus der Uni S-H, Campus … · 2017-12-08 · © 2015 Schön...

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