MATERIALS AND METHODS: Three different makes of ceramic brackets, Pure Sapphire(M), Clarity™ ADVANCED(P) and Dual Ceramic(P) were used. Eighteen specimens of each make were prepared and allocated to three groups (n = 6). MARC(®)-resin calibrator was used to determine the light curing unit (LCU) tip irradiance (mW/cm(2)) and TLE (J/cm(2)) transmitted through the ceramic brackets, and through ceramic bracket plus Transbond™ XT Light Cure Adhesive, for 5, 10 and 20 s. Vickers-hardness values at the bottom of the cured adhesive were determined. Statistical analysis used one-way analysis of variance (ANOVA); P = 0.05.
RESULTS: TLE transmission rose significantly among all samples with increasing exposure durations. TLE reaching the adhesive- enamel interface was less than 10 J/cm(2), and through monocrystalline and polycrystalline ceramic brackets was significantly different (P
METHODS: Between 2006 and 2012, 22 patients underwent revision surgery using MoM bearing (28 mm femoral head in 18 hips and 32 mm in 4 hips) for ceramic bearing fracture and followed average 52.1 months. We assessed radiological parameter and functional outcome using Harris hip score (HHS) and WOMAC score. Also, serum cobalt (Co) and chromium (Cr) blood tests were performed and compared with the result obtained from age, sex- and follow-up duration-matched patients with MoM revision THA for failed polyethylene bearing.
RESULTS: The mean HHS improved from 60.6 preoperatively to 90.3 at final follow-up. There were no changes in cup position, progression of osteolytic lesions, and measurable wear of MoM bearing articulation at final follow-up radiographs. There was one case of recurrent dislocation after surgery, which was treated with greater trochanter distal advancement and one case of deep infection, which underwent two-stage revision. Mean serum Co level (1.7 vs. 1.4 μg/dl; p = 0.211) and Cr level (0.70 vs. 1.01 μg/dl; p = 0.327) showed no significant difference.
CONCLUSIONS: MoM articulation with liner cementation into the acetabular cup along with total synovectomy can be chosen in revision surgery for ceramic fracture with good midterm follow-up. However, the use of MoM bearing is indicated when the stem and metal shell can be retained and ceramic on ceramic or ceramic on polyethylene bearing cannot be selected. Also long-term outcome needs to be further evaluated.