Ceramic Bearings for Total Hip Arthroplasty Have High Survivorship at 10 Years

Abstract

Background Ceramic bearings were introduced to reduce wear and increase long-term survivorship of total hip arthroplasty. In a previous study comparing ceramic with metal-on-polyethylene at 5 to 8 years, we found higher survivorship and no osteolysis for the ceramic bearings. Questions/Purposes We asked whether ceramic bearings have equal or superior survivorship compared with that for metal-on-polyethylene at longer followup; we also determined survivorship of the implant systems, the presence or absence of radiographic osteolysis, and incidence of device squeaking.Methods Five surgeons at five sites have followed 189 patients (216 hips) for a minimum of 10 years and average of 10.3 years (range, 10-12.4 years) comparing alumina ceramic bearings (144 hips) with cobalt chromeon-polyethylene bearings (72 hips). We determined KaplanMeier survivorship of the bearing surface and implant systems and collected radiographic and clinical data. Results We observed no difference between the control metal-on-polyethylene and the alumina-bearing couple cohorts with regard to bearing-related failures (98.9% versus 99.1%). Revisions for any reason occurred in 10

Comparative Effectiveness of Ceramic-on-Ceramic Implants in Stemmed Hip Replacement

“…Several studies with various follow-up durations have compared C-C bearings with C-P bearings 15,[32][33][34][35][36][37] ; most had both baseline and postoperative measurements. In addition, one trial compared C-C with M-P bearings; this had only postoperative measurements [11][12][13][14] .…”

“…However, one well-designed study indicated substantially more intraoperative device and wound complications associated with C-C compared with C-P bearings 32 . The previously mentioned trial comparing C-C with M-P bearings [11][12][13][14][15] indicated a substantially lower occurrence of revision in the C-C arms compared with the M-P arm even after ten years of follow-up. The comparison M-P group involved non-cross-linked polyethylene, and the authors did discuss the uncertainty regarding the applicability of their findings to M-HXLPE bearings.…”

“…In the U.S., interest in C-C bearings started after multiple publications based on an FDA IDE (Food and Drug Administration Investigational Device Exemption) trial, a part of the pre-market application process, that compared C-C with metal-on-polyethylene (M-P) bearings [11][12][13][14][15] . That study had randomized and nonrandomized arms and indicated a substantially lower occurrence of revision in the C-C arms compared with the M-P arm even after ten years of follow-up 15 . However, C-C implants have various limitations such as breakage, squeaking (audible componentrelated noise), liner chipping, and canting 16,17 .…”

There Are No Differences in Short- to Mid-term Survivorship Among Total Hip-bearing Surface Options: A Network Meta-analysis

“…At both stages of selection, we estimated chance-adjusted agreement statistics among reviewers with a j statistic (j = 0.917 for abstract review; j = 1.000 for full-text review), and all disagreements were settled by the opinion of a third senior reviewer (GAN-M). Eleven articles [2,4,5,8,14,22,28,33,40,41,49] were deemed eligible through this process and seven studies [9,[16][17][18][19][20][21] were added following a manual search of the bibliographies of the 11 chosen articles for a final study cohort of 18 manuscripts (Fig. 1).…”

How Have Alternative Bearings and Modularity Affected Revision Rates in Total Hip Arthroplasty?

“…However, some metal-on-metal (MoM) THA designs have been associated with premature revisions related to acute local reactions and high systemic metal ion levels, and reports of ceramic component breakage and squeaking have raised questions about the cost-benefit balance with those implants as well [10,16,32,33,36,38,50,52,60,66,69,77].…”