Background: The purpose of this retrospective
study was to report the results, after a minimum of 18.5 years of
follow-up, in a consecutive series of total hip arthroplasties performed
with an alumina-on-alumina combination.
Methods: One hundred and eighteen consecutive total
hip arthroplasties were performed in 106 patients between 1979 and
1980. The prostheses combined a 32-mm alumina head and an all-alumina
socket. Both components were cemented in eighty-five hips, both
components were implanted without cement in twenty-nine, and only
the stem was cemented in four. The mean age of the patients at the
time of the index arthroplasty was 62.2 years (range, thirty-two
to eighty-nine years).
Results: At the 18.5 to 20.5-year follow-up evaluation,
forty-five patients (fifty-one hips) were alive and had not had
a revision, twenty-five patients (twenty-five hips) had undergone
revision of one or both components, twenty-seven patients (thirty
hips) had died, and nine patients (twelve hips) had been lost to
follow-up. The mean Merle d’Aubigné hip score
(and standard deviation) was 16.2 ± 1.8 points at
the latest follow-up evaluation. The rate of survival at twenty
years, with revision for any reason as the end-point, was 85.6% for
the cementless cups compared with 61.2% for the cemented
cups and 84.9% for the cementless stems compared with 87.3% for the
cemented stems. Wear of the prosthetic components was undetectable
on plain radiographs. Periprosthetic cystic or scalloped lesions
requiring the use of allograft bone during revision were present
in three of the twenty-five revised hips. In addition, seven hips
had moderate acetabular osteolysis treated with a 4-mm-larger cup.
No fracture of the alumina socket or head was recorded. The mean
acetabular wear rate in this series was <0.025 mm/yr.
Conclusion: With the alumina-on-alumina total hip
arthroplasty, minimal wear rates and limited osteolysis can be expected
up to twenty years after the operation, provided that sound acetabular
component fixation is obtained.