Background: Ceramic-on-ceramic couplings are attractive alternative
bearing surfaces that have been reported to eliminate or reduce problems
related to polyethylene wear debris. Disappointing experiences with alumina
ceramic bearings in the past have led to many improvements in the manufacture
and design of ceramic implants. The purpose of the present study was to report
the results of contemporary alumina-on-alumina total hip arthroplasties with
regard to wear, osteolysis, and fracture of the ceramic after a minimum
duration of follow-up of five years.
Methods: We evaluated the results of a consecutive series of 100
primary alumina-on-alumina total hip arthroplasties that had been performed
with use of a metal-backed socket and a cementless stem in eighty-four
patients. All of the patients were sixty-five years of age or younger (mean
age, forty-one years), and a single surgeon performed all of the procedures.
After a minimum duration of follow-up of sixty months, one patient (one hip)
had died and four patients (six hips) had been lost to follow-up, leaving a
total of seventy-nine patients (ninety-three hips) available for study. All of
these patients were evaluated clinically and radiographically with special
attention to wear, periprosthetic osteolysis, and ceramic failure.
Results: The mean Harris hip score was 97 points at the time of the
latest follow-up evaluation. All prostheses demonstrated radiographic evidence
of bone ingrowth. No implant was loose radiographically, and no implant was
revised. Ceramic wear was not detectable in the thirty-seven hips in which the
femoral head could be differentiated from the cup on radiographs.
Periprosthetic osteolysis was not observed in any hip. A fracture of the
alumina femoral head and a peripheral chip fracture of the alumina insert
occurred in one hip following a motor-vehicle accident.
Conclusions: The results of contemporary alumina-on-alumina total
hip arthroplasty with a metal-backed socket and a cementless stem were
encouraging after a minimum duration of follow-up of five years. We believe
that these improved alumina-on-alumina bearing implants offer a promising
option for younger, active patients.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.