The Wear Rate and Survivorship in Total Hip Arthroplasty Using a Third-generation Ceramic Head on a Conventional Polyethylene Liner: A Minimum of 15-year Follow-up

Abstract

Purpose The purpose of this study was to evaluate the wear and survival rates of third-generation ceramic heads on a conventional ultra-high molecular weight polyethylene liner. Materials and Methods A total of 160 hips (147 patients with a mean age of 55.9 years) who underwent total hip arthroplasty using the third-generation ceramic head on a conventional polyethylene liner from March 1998 to August 2003 were reviewed retrospectively. Evaluation of the wear rate for 56 hips (49 patients) followed-up for at least 15 years was performed using the PolyWare program version 8 (Draftware Developers, USA). The Kaplan–Meier survivorship was also evaluated. Results Linear wear and volumetric wear rates were 0.11±0.47 mm/year and 32.75±24.50 mm 3 /year, respectively. Nine revisions were performed during the follow-up period because of cup or stem loosening. The Kaplan–Meier survival rate, using cup revision or total revision total hip arthroplasty (THA) as the endpoint of analysis, was 93.7% at 15 years and 73.6% at 20 years. Conclusion Because all revisions were performed between 15 and 20 years in our study, surgeons should pay greater attention to patients who underwent THA with ceramic-on-polyethylene bearing from 15 years postoperatively. Contemporary alumina ceramic on highly cross-linked polyethylene could certainly be a good alternative bearing couple providing better longevity.

Safety of Using a Large Femoral Head on Thin Polyethylene for Total Hip Arthroplasty Based on Different Types of Polyethylene

“…Digital imaging software (PolyWare; Draftware Developers Inc., Vevay, IN, USA) was used to measure anteversion and inclination of the acetabular cup 14,15 . The software also calculated the linear and volumetric wear rates.…”

Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy

“…Combinations including PE and ceramic or metal are called “hard-on-soft” (most commonly used) and those without PE “hard-on-hard”. The bearing surface is a significant factor in determining the longevity of THA, as worldwide concerns regarding expanding burden for revision procedures are emerging, secondary to loosening and osteolysis, depending on the type of bearing couples [ 52 ].…”

“…However, the optimal bearing surfaces are still under debate. PE liners are often used on the acetabular side, regardless of the artificial head [ 52 ]. MoM THA with large femoral head diameters have led to a high rate of adverse reactions to metal debris and pseudo-tumors, leading to an almost worldwide cessation of their use and reinforced surveillance [ 53 ].…”

“…MoP bearing was known to lead to particles disease secondary to contact pressure-induced wear, but recent data showed that the use of an acetabular ultra-high molecular weight PE cup in association with a titanium alloy femoral head could reduce the wear rate compared to cobalt chromium molybdenum and stainless steel so that it can extend the life of THA, in developing countries, especially for Indonesian and, more widely, Asian people [ 6 ]. Additionally, to decrease the amount of PE wear debris, alumina ceramics can be used with newer PE, with good long-term functional and radiologic outcomes, so that CoP is thought to be an excellent bearing couple and accounts for more than half of THA in the USA [ 52 ]. CoC bearings have been widely used in Korea for economic purposes but can lead to ceramic fractures and squeaking.…”

“…CoC bearings have been widely used in Korea for economic purposes but can lead to ceramic fractures and squeaking. Those specific complications rate might be dramatically decreased by the use of CoP bearing surfaces [ 52 ].…”