Medium-term Analysis of Modern Ceramic-On-Ceramic Bearing in THA

Abstract

A variety of different bearing surfaces have been used to avoid osteolysis following hip replacement. We report a retrospective review of medium-term results of a modern ceramic-ceramic bearing (Biolox, CeramTec, Plochingen, Germany) and uncemented components (Alpha Cera Fit Alphanorm, Lassnitzhohe, Austria) in 107 hip arthroplasties. The clinical outcome based on serial radiographs and scoring was assessed with a minimum follow-up of 7 years (mean, 7, 6 years; range, 7, 1-8, 3 years). The average age of the patients at surgery was 64, 6 + 11, 7 years (range: 21-88 years). The mean Harris hip score was 90, 4 (range, 84, 7-99, 2). Three patients with an extra long femoral neck experienced fracture of the ceramic femoral head, resulting in cessation of use of this combination. Radiological evaluation did not reveal any signs of lysis or loosening. Massive heterotopic ossification was seen in three patients. Medium-term follow-up showed excellent clinical and radiological results. Continued follow-up will be required to determine if this ceramic-on-ceramic bearing is associated with extended survivorship.

Fracture of Ceramic Bearing Surfaces following Total Hip Replacement: A Systematic Review

“…The majority of these manuscripts are case reports and retrieved analysis of fractured heads [28, 29, 35–41, 43–45, 48–51]. The remaining studies reported on the incidence of fractured ceramic heads in retrospective case-series on the mid to long term outcomes of COC hip prostheses [20–22, 24–28, 30, 42, 46]. A trauma was involved in the generation of fractures in 7 reports [24, 26, 27, 35, 42, 46, 48].…”

Early loosening of a press-fit cup with ceramic-on-ceramic articulation: our early results

“…Zhou et al [12] investigated the phenomenon of stiff implants and early loosening by randomizing patients to ceramic-ceramic or PE-ceramic bearing and followed migration of the cup in the first 2 years showing no difference between the ceramic-ceramic or PE-ceramic bearing. Although there is a lack of clinical evidence of this potential cause of loosening, stiffness of the implant may be at least theoretically a factor in preventing osseointegration and early loosening [13][14][15][16].…”

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

“…Several studies have demonstrated survivorship of up to 97% in studies of ceramic-on-ceramic bearing surfaces with followup close to 10 years [2,8,9]. Survival rates in the reported literature of medium-term followup for ceramicon-ceramic THA range from 94% to 97% [2,6,8,20,27].…”

“…Survival rates in the reported literature of medium-term followup for ceramicon-ceramic THA range from 94% to 97% [2,6,8,20,27]. Aldrian et al [2], reporting on a series of 107 ceramic-onceramic THAs, found at a mean followup of 7.6 years (range, 7.1-8.3 years) three failures, resulting in a 97% survival rate. This is consistent with the Kaplan-Meier survival rate reported in our study of 98%.…”

“…Of the 537 hips, all 431 ceramicon-ceramic articulations were alumina-ceramic, and the 106 remaining hips were cobalt-chromium-on-PE bearing surfaces. Inclusion and exclusion criteria for the two studies were identical, and patients were considered for inclusion if they (1) agreed to the informed consent; (2) were between the ages of 21 and 75 years at the time of enrollment; (3) were not morbidly obese; (4) clinically qualified for THA; (5) were diagnosed with noninflammatory degenerative joint disease; (6) did not have a hip infection; (7) had not had a prior fusion or THA on the affected side; (8) were physically and mentally able to comply with all postoperative evaluations; (9) did not have a neuromuscular or neurosensory disorder; (10) did not have a systemic disorder (eg, osteoporosis, Paget's disease, or renal osteodystrophy), were not immunosuppressed, and were not receiving corticosteroid therapy; (11) were skeletally mature; (12) were not pregnant; (13) were not a prisoner; and (14) were not planning on relocating to a different geographical region during the study period [8,9]. All excluded patients received the metal-on-PE articulation.…”