Cementless Total Hip Arthroplasty with Alumina Bearings in Patients Younger Than Fifty with Femoral Head Osteonecrosis

Abstract

After a minimum of six years of follow-up, this cementless total hip arthroplasty with contemporary alumina bearings was found to be a promising procedure for young, active patients with osteonecrosis of the femoral head. However, we remain concerned about the long-term implications of the noise that was reported in these hips.

Alumina-on-alumina THA Performed in Patients Younger Than 30 Years: A 10-year Minimum Followup Study

“…According to a 10-year followup study by Kim et al [21], no osteolysis was observed in 93 hips of patients operated on when the patients were younger than 45 years, and this result was supported by CT scans. Similar results were reported by Baek and Kim [1]. In our study, no appreciable osteolysis was observed by plain radiography (Table 3).…”

“…Several reports describe alumina-on-alumina bearings used in THAs in young patients [1,3,19,30], and report survivorship ranging from 91% to 99% at 7 to 11 years [10,11,21,24]. We previously reported 5-year followup results of patients younger than 40 years [38], and 10-year followup results in a series of 100 patients [24].…”

Ceramic-on-ceramic THA Implants in Patients Younger Than 20 Years

“…The results of ceramic-on-ceramic bearings in patients who were older than 40 years have been reported [2,3,16,29,30], but few [6,15,23] have focused on the long-term results of ceramic-on-ceramic implants in patients younger than 20 years. In this series, we found the survivorship of ceramic-on-ceramic implants in adolescent patients was encouraging, averaging 90.3% at 10 years.…”

“…Five patients reported some transient noise (one squeak), but none underwent revision surgery for this problem. The proportion of patients reporting squeaking varies considerably, ranging from less than 1% to 20% [2,24]. In a prospective observational study of 1486 ceramic-on-ceramic THAs, 95 hips (6%) had squeaking develop [36].…”

“…Ceramic-on-ceramic bearing couples have become an alternative to standard surface bearing couples (such as metal-on-polyethylene) because of decreased wear production and lower rates of osteolytic lesions compared with metal-on-conventional polyethylene [21]. The results of modern ceramic-on-ceramic bearings are available in patients younger than 60 years who have degenerative diseases [2,3,16,29,30], but few reports [6,15,23] have focused on patients younger than 20 years, who may be more likely to have high activity levels, perform sports activities, or engage in higher-demand workplace tasks.…”