Clin Orthop Surg.  2013 Sep;5(3):174-179. 10.4055/cios.2013.5.3.174.

Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study

• Choy WS
• Kim KJ
• Lee SK
• Bae KW
• Hwang YS
• Park CK

• KMID: 1705542
• DOI: http://doi.org/10.4055/cios.2013.5.3.174

Abstract

BACKGROUND
This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years.
METHODS
We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures.
RESULTS
The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years.
CONCLUSIONS
The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.

Keyword

Hip; Total hip arthroplasty; Ceramic-on-ceramic

MeSH Terms

Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip/adverse effects/instrumentation/*methods
*Ceramics
Female
Follow-Up Studies
Hip Joint/radiography/surgery
*Hip Prosthesis
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Pain, Postoperative/etiology
Prosthesis Failure
Range of Motion, Articular
Ceramics

Figure

• 

  Fig. 1 Radiographs of the right hip of a 65-year-old male showing avascular necrosis of femoral head (A) whom underwent ceramic-on-ceramic total hip arthroplasty (B). Radiograph showing ceramic head fracture at postoperative 62 months (C). Fractured ceramic head particles were removed and revision total hip arthroplasty was done (D).

• 

  Fig. 2 The Kaplan-Meier survival rate of prostheses was 98.1% at postoperative 7.8 years (95% confidence interval).

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