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device over a 5 year period based on the initial favorable experience of a small pilot group.Alternative scenarios were modeled, including limited release of the device (65 surgeons/64cases each), increased distribution (310 surgeons\20 cases), and rapid early promotion (250surgeons\24cases). Computer routines were utilized to predict the expected failure rate of eachprocedure using a standard survivorship curve based on surgeon experience.ResultsThe method of introduction of the implant had a significant effect on its survivorship. Limiteddistribution to a smaller number of higher volume surgeons reduced the revision rate by 10%from 3.43% to 3.09% at 5 years. Conversely, early use of the device by twice the number ofsurgeons reduced survivorship by 4%. The greatest effect was observed with rapid earlypromotion of the new implant which led to a 23% increase in revisions at 5 years.DiscussionThis approach, using a "synthetic" database, predicts that the rate of commercial introduction ofnew devices can affect the survivorship data reported by joint registries. Because of the effect ofthe learning curve on implant survivorship, staged introduction of new devices is recommendedto reduce adverse effects of inevitable early failures.Poster: 73Metalosis and Third-Body Wear on Cross-Linked Polyethylene and CobaltChromium Following Revision Total Hip ArthroplastySean O'Brien - Concordia Joint Replacement - Winnipeg, CanadaColin Burnell - Concordia Joint Replacement Group - Winnipeg, CanadaDavid Hedden - Concordia Joint Replacement Group - Winnipeg, CanadaFractured ceramic-on-ceramic hip replacements in vivo can create third-body abrasive wearparticles that reduce the longevity of following revision arthroplasties. The present case studyreports on the effects of third-body wear on a cross-linked polyethylene (XPE) acetabular linerand a cobalt chromium (CoCr) alloy femoral head due to ceramic particles.A thirty-four year old female patient received a ceramic-on-ceramic total hip replacement fortreatment of osteoarthritis in her left hip (Biolox, Ceramtec AG, Plochingen, Germany;Transcend, Wright Medical, Memphis TN). After sixty-five months of implantation, the patientsuffered a fall and developed severe pain. The patient experienced difficulty walking andnoticed squeaking and a grinding sensation and underwent her first revision hip arthroplasty.Intraoperatively, the patient was found to have experienced a fracture on the rim of theacetabular ceramic liner. The ceramic-on-ceramic hip was revised with a XPE acetabular linerand a 36 mm CoCr alloy femoral head (Longevity, Zimmer Inc., Warsaw IN). The retrievedtotal hip implants were assessed using gravimetric techniques, scanning electron microscopy,and non-contact profilometry.file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]