Schön Klinik Neustadt, Lehrkrankenhaus der Uni S-H, Campus … · 2017-12-08 · © 2015 Schön Klinik Seite 1 Clinical experience with more than 4.800 CoC P. Dufek Schön Klinik

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

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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

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

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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)

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

Co/Cr/Ni

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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!

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Silony Medical Int.

own company for endoprothesis

MicroPort Profemur Preserve

BIOLOX®delta (CeramTec)-

use in our clinic since 2005

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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

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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

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Advantage -

Good stability and ROM of the hip after dysplastic-arthrosis

CoC 36 mm

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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

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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

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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

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• 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

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Revisions for Infection (500’749 pats)

Streicher, 2014

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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 !

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One week after THR with CoC & fast track rehabilitation

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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

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Thank you and you are welcome in Neustadt in Holstein