Dr. Trousdale:So age to me is not that important in the sense of cobalt chrome or ceramic and certainly the trunnion problem has not been age discriminatory. So, I have an 82-year-old patient, 6 years from surgery who’s getting revised for high cobalt levels and a big pseudotumor. If you are concerned about cost, there is good data on elderly patients with type C bone and a cemented stem. Use a cemented stainless-steel stem and a stainless-steel head—that corrodes! But the byproducts of stainless-steel corrosion don’t seem to be as clinically relevant as the byproducts of a cobalt chrome head.
Moderator Thornhill:Yeah, and it occurs sort of alarmingly quickly within a few years, so I think it’s a good point. Rob, you know the early iterations of ceramic heads had issues with fractures, chipping, squeaking, stripping, we fixed all of that?
Dr. Trousdale:I’ve never seen a squeaking hip with a highly crosslinked poly. Ceramic-ceramic is a different can of worms. You’ve not solved that problem. I think most us, at least in the United States, are using Delta heads. Now whether that the right thing or not, I think it’s still unknown. They certainly seem to be stronger, the fracture rate seems to be very low with the femoral heads different with Delta liners. With the zirconia that’s in the Delta, 18-20% zirconia, is that going to be a factor long-term, maybe? We don’t know, there is still some unknown with Delta ceramic as it’s relatively new.
Dr. Engh:I am very happy with the Delta heads. I have some worries about the additional modularity, sometimes you do have to put a taper sleeve in some of these ceramic heads.
Dr. Trousdale: You do, but most of those sleeves are, of course, titanium and the byproducts of titanium-on-titanium, certainly you get corrosion in that interface, but the clinical significance seems to be lower than cobalt chrome-on-titanium. That we can agree on.
Moderator Thornhill:That was my next question about the sleeved heads. Pros and cons and the reason for those that haven’t been using them.
Dr. Trousdale:I think if you are putting a ceramic head on a used trunnion, it’s probably prudent to use that titanium sleeve. You’re going to get corrosion. Again, pick your poison, you’ve got titanium poison or cobalt chrome poison. I’ll pick titanium poison any day of the week.
Dr. Engh:I agree with that completely.
Dr. Trousdale:I agree with Andy agreeing.
Moderator Thornhill: Thank you. You two did a great job because you actually changed the debate, that’s just brilliant. We are seeing an increase in the use of ceramic heads.
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