Two- to 9-Year Clinical Results of Alumina Ceramic-on-Ceramic THA

Abstract

we performed 194 total hip arthroplasties on 173 patients using alumina ceramic-onceramic bearings as part of a prospective United States Food and Drug Administration/Investigational Device Exemption study. The average patient age at surgery was 49.9 years. Minimum followup time was 2 years (mean 4.3 years, range 2−9 years). We evaluated survival rate, implant-and nonimplant-related complications. Clinical outcomes included the Merle d'Aubigné score. We assessed radiographs for signs of osteolysis, component loosening, and implant wear. No patients had osteolysis and there were no hip dislocations. Implant survivorship for all hips with aseptic revision of any component was 96% (CI, 91-100) at 9 year; survivorship for hips without prior surgery was 99.3%, (CI, 98-100). There was a 1.7% incidence of implant-related complications. Our data help confirm two United States FDA/IDE studies on alumina ceramic-on-ceramic total hip arthroplasty that reported low aseptic revision rates and low revision rates for instability. Total hip arthroplasty using alumina ceramic-onceramic implants is a safe and reliable procedure in the comparably young and active patient.Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Traditional total hip arthroplasty (THA) using metal-onpolyethylene bearings has been established as a reliable procedure. 6 However, wear and wear debris-associated osteolysis are still among the most common complications affecting these devices. Several alternative bearings have been used clinically to reduce wear and osteolysis.39 The alternatives include cross-linked polyethylene acetabular liners, metal-on-metal bearings, and alumina ceramic-onceramic bearings. Although metal-on-cross-linked polyethylene is most commonly used, these bearings have the shortest clinical experience of the available alternative bearings. 10Generally, good results with these improved polyethylene implants have been reported by several authors, 10,27,33 especially compared to the older-generation conventional polyethylene bearings. However, theoretical concerns include a relatively poor resistance to scratching and thirdbody wear compared with hard bearings. Cross-linked polyethylene bearings may be more susceptible to fracture and dissociation as compared to conventional polyethylene because of their low resistance to crack propogation. 16Whether these material factors will substantially affect long-term clinical outcomes remains to be seen.Metal-on-metal bearings have demonstrated substantially improved wear characteristics as compared to metalon-conventional polyethylene bearings. Long-term clinical studies also suggest these bearings represent a promising alternative method of achieving improved THA longevity. 3,8 Yet, theoretical concerns about wear from these bearings remain because wear debris produces an inflammatory response of the surrounding tissue.38 Some authors have suggested this response may lead to component loosening or implant-induced osteol...

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

“…We found the survivorship of implants with alumina-onalumina bearings was 98.9% in the best-case scenario and 83.1 % in the worst-case scenario, at 10 years, which are similar to the survival rates reported for older patients [23,28,31]. Numerous reports have been published on alumina-on-alumina bearings in THAs in young patients ( Table 3).…”

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

“…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.…”

Incidence of ‘Squeaking’ After Ceramic-on-Ceramic Total Hip Arthroplasty

“…At a minimum of 18.5 years followup, Hamadouche et al reported minimal wear, limited osteolysis, and a low rate of complication with COC THA [6]. The American experience at short-and midterm followup suggests similar outcomes [1,4,5,10]. However, recently described hip noise (''squeak'') associated with COC bearings has been reported and has caused concern among clinicians and patients [12,16].…”