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Third-Generation Alumina-on-Alumina Ceramic Bearings in Cementless Total Hip Arthroplasty
P.J. Lusty, FRCS(ORTH)1; C.C. Tai, FRCS(ORTH)1; R.P. Sew-Hoy, MBBS, FRACS, FAOrthA1; W.L. Walter, MBBS, FRACS, FAOrthA, PhD1; W.K. Walter, MBBS, FRACS, FAOrthA1; B.A. Zicat, MD, FRACS, FAOrthA1
1 Sydney Hip and Knee Surgeons, Level 3, 100 Bay Road, Sydney, NSW 2060, Australia. E-mail address for W.L. Walter: bill.walter@hipknee.com.au
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Stryker Orthopaedics and DePuy) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at Sydney Hip and Knee Surgeons, Sydney, Australia

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2007 Dec 01;89(12):2676-2683. doi: 10.2106/JBJS.F.01466
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Background: Wear debris has been implicated in the pathogenesis of osteolysis. Alumina-on-alumina ceramic bearings have a low wear rate, which may reduce the prevalence of osteolysis. The purpose of this study was to determine the rates of wear and osteolysis associated with modern cementless hip arthroplasty with alumina-on-alumina bearings at five years.

Methods: We analyzed a series of 301 third-generation alumina-on-alumina cementless primary total hip replacements in 283 patients. The average age of the patients at the time of the arthroplasty was fifty-eight years. All procedures were performed with use of the same surgical technique and the same implant at a single center. At a minimum of five years postoperatively, ten patients had died and twenty-two patients were lost to follow-up. We assessed patients clinically and radiographically, and all retrieved bearings were analyzed for wear.

Results: At the time of the latest follow-up, the mean Harris hip score was 95 points. All surviving implants had radiographic evidence of stable bone ingrowth. There were nine revisions of one or both components. Four stems were revised following periprosthetic fracture, one stem was revised because of aseptic loosening at two months, and one stem was revised to facilitate a femoral shortening osteotomy. Two cups were revised because of psoas tendinitis, and both components of one arthroplasty were revised because of impingement and osteolysis. The rate of survival of both components, with revision because of aseptic loosening or osteolysis as the end point, was 99% at seven years. The retrieved femoral heads showed an early median wear rate of 0.2 mm3 per year.

Conclusions: Cementless primary total hip prostheses with a third-generation alumina-on-alumina bearing showed very low wear and were associated with minimal osteolysis at the time of follow-up, at a minimum of five years.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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