Contemporary alumina‐on‐alumina total hip arthroplasty performed in patients younger than forty years: A 5‐year minimum follow‐up study

Abstract

Ceramic-on-ceramic bearing surfaces in total hip arthroplasties (THAs) are an attractive alternative coupling and may offer a promising option for young active patients. We evaluated the clinical results of 72 contemporary primary cementless alumina-on-alumina THAs performed in 61 patients younger than 40 years (mean age, 30 years), after a 5-year minimum follow-up. Most patients (97%) were able to return to their prearthritic activity levels, and none changed occupation because of a postoperative hip joint problem. No implant loosened radiographically and no stem or cup was revised. Ceramic wear was undetectable in 24 hips, where differentiation of the femoral head from the cup was possible on radiographs and no osteolysis was observed. One ceramic fracture following a major motor vehicle accident and a recurrent subluxation-associated ceramic liner edge fracture attributed to inadequate hip muscle tone occurred. We believe that this alternative articulation offers a promising option for young active patients. However, our findings also suggest that contemporary ceramic implant fracture is not a potential, but a real danger. Careful preoperative patient evaluation, proper indications for ceramic bearings, and meticulous surgical techniques are recommended to minimize the possibility of modern ceramic failure.

Ceramic-on-Ceramic Total Hip Arthroplasty in Patients Younger Than 55 Years

“…The mean UCLA Activity Score improved from 4.0 (range, 1-10) to 7.7 (range, [2][3][4][5][6][7][8][9][10] 52 (80%) patients were satisfied with their activity level. 28 (43%) patients reported no activity limitation, and 37 (57%) reported limitation caused by pain (n=8), squeaking (n=1), musculoskeletal (n=15), or psychological reasons (disinterest in greater activity or fear of accelerating bearing wear) [n=13].…”

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

“…In another report, 97% of patients were able to participate regularly in moderate activities such as housework, shopping, and light occupational work [38] (Table 3). Similarly, in our study, most patients (97%) were able to participate regularly in moderate activities and nearly half of the patients (48%) can regularly participate in active sports.…”

“…However, early ceramic-on-ceramic implants were characterized by component fracture and by loosening of monoblock acetabular components with overall failure rates ranging from 4% to 27% at 2 to 11 years [14,19,25,42]. Technologic advances in implant materials and fixation methods reduced the early failure rates to 0% to 9% at 4 to 8 years [10,21,30,38,42], although it is unclear whether they have increased the long-term survivorship of THAs in young, active patients.…”

“…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]. One of these studies showed that survivorship of patients with mean age of 41 years was 99% at 10 years [24], but the data were not analyzed for patients younger than 30 years and for these patients followup of much longer than 10 years is important.…”

Alumina-on-Alumina Hip Arthroplasty in Patients Younger Than 30 Years Old

“…The major positive finding in our patients was a very low occurrence of osteolysis (observed in only one hip in one femoral zone). A low rate of osteolysis has previously been reported in one long-term followup of alumina-on-alumina combinations [28] and in several studies focusing on younger and/or active patients [13,25,41,47], it was judged related to the tribologic performance of these bearing surfaces that produce minimal wear debris and therefore minimal reaction to wear debris. Minimizing osteolysis and preservation of the bone stock is of particular importance in the younger population; it should be considered as a primary goal because these patients may need more than one prosthesis during their lifetime and the failure of the first one should not make the second or the third one too uncertain.…”