Survival of Hard-on-Hard Bearings in Total Hip Arthroplasty: A Systematic Review

Abstract

While hard-on-hard bearing survival rates have generally been variable with earlier designs, contemporary implants have demonstrated survival of 95% or greater at followup of between 3 and 10 years. Some variability in survival may be due to differences in surgical technique, component positioning, and implant designs. As bearing designs continue to improve with modified materials and manufacturing techniques, use will increase, especially in young and active patients, though concerns remain about the increased reports of adverse events after metal-on-metal bearings.

Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

“…These rates were consistent with other studies documenting similar success with the use of alternative bearings [18,31]. Our study retrospectively reviewed a combined 2869 patients who underwent hard-on-hard THA.…”

“…Wear rates of MOM and COC hip prostheses reportedly have two to three times less volumetric wear than metal-on-polyethylene (MOP) when tested in laboratory settings [5]. MOM articulations allow for larger head-neck ratios than current options for MOP, which allows for a larger ROM before impingement and stability [31]. Recent studies demonstrated largerdiameter metal heads decreased dislocation rates to as low as 0.05% and were able to better approximate anatomic femoral heads in primary arthroplasty [21], while other studies found a higher rate of revision for dislocation, up to 0.8% in hard-on-hard THA, particularly with the use of smaller head sizes [26].…”

“…For metals, the major concerns are adverse tissue reactions of various descriptions and, to a lesser degree, failure of ingrowth or early loosening of components. Various authors reported the frequency of fracture of contemporary devices between 0.004% and 0.19% [27,30,31] and squeaking between 1% and 21% [3,16,28]. The incidence of major tissue reactions is unknown currently, but some believe it to be around 1% or less [2] and that of early loosening to be between 1% and 6% [11].…”

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

“…failure rates ranging from 14% to 45% at 10 to 25 years [13,36,37], which has caused many surgeons to be cautious when recommending THA in this patient population despite expected short-term relief of pain and improvements in function, quality of life, and overall health. Furthermore, despite improvements in the techniques and implants such as cementless components and the use of alternative bearing surfaces, including ceramic-on-ceramic surfaces, the risk of early failure remains a concern [42].…”

“…The low wear rates of alumina-on-alumina bearings reportedly reduce osteolysis and preserve bone stock, both of which are important considerations in young patients who are expected to require revision surgery at some stage [10,19]. 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.…”