Zirconia ageing is related to total hip arthroplasty aseptic loosening. A study of 45 retrieved zirconia heads - 10/09/24

Doi : 10.1016/j.otsr.2024.103991

Bertrand Boyer ^a,^b,^c,⁎ , Juliana Uribe ^d, Manon Launay ^c,^e, Jean-Luc Aurelle ^f, Rémi Philippot ^a,^g, Jean Geringer ^b,^h
^a Chirurgie Orthopédique et Traumatologie, CHU Saint-Etienne, France
^b Univ Jean Monnet, INSERM, Mines Saint-Étienne, U1059 SAINBIOSE, 42270 Saint-Étienne, France
^c Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc) de Saint Etienne, 42270 Saint-Étienne, France
^d Universidad de Antioquía, Department of Bioengineering, Medellin, Antioquia, Colombia
^e Centre Régional de Pharmacovigilance, CHU de Saint Etienne, 42270 Saint-Etienne, France
^f MENIX Group, Conservatoire National des Arts et Métiers, 85 Avenue des Bruyères, 69150 Décines, France
^g Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), Université Jean Monnet, Saint Etienne Cedex 2, 42055, France
^h Mines Saint-Etienne, INSERM, U1059 SAINBIOSE, Univ Jean Monnet, 42270 Saint Etienne, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 10 September 2024

Abstract

Background

Y-TZP zirconia heads were recalled by the Food and Drug Administration (FDA) in 2001 and zirconia alone was no longer used in orthopedics. Tunnel furnace sintering was suspected of producing defects responsible for early material failure. As Zirconia Toughened Alumina (ZTA) matrices are widely used as bearing material and contain zirconia grains, there remains a need to better understand the in vivo ageing process of zirconia and its clinical implications when the material is produced by batch furnace sintering, the validated sintering process.

Questions/objectives

Is there an association between the ageing of batch furnace produced zirconia and THA revision?

Methods

45 retrieved femoral heads, batch furnace sintered only, were analyzed. Roughness was measured by 3D profilometry, phase transfer by μRaman spectroscopy.

Clinical data were compared with material characteristics.

Results

Irrespective of the cause of revision, all heads showed a crystallographic phase transition from tetragonal to monoclinic over 19.5%. A correlation was found between the phase change, roughness increase and aseptic loosening, with a threshold set at 24.5% of monoclinic phase.

Conclusions

The ageing process of zirconia may lead to aseptic loosening, which, in the absence of contrary evidence, prohibits its use as the sole component of orthopedic materials. ZTA matrices should be clinically monitored, especially in young patients, and better in vitro modelling needs to be performed.