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Long-Term Performance of Ceramic and Metal Femoral Heads on Conventional Polyethylene in Young and Active PatientsA Matched-Pair Analysis
Morteza Meftah, MD1; Gregory G. Klingenstein, MD1; Richard J. Yun, BS1; Amar S. Ranawat, MD1; Chitranjan S. Ranawat, MD1
1 Weill Medical College of Cornell University, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for M. Meftah: MeftahM@HSS.edu
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Investigation performed at the Hospital for Special Surgery, New York, NY



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jul 03;95(13):1193-1197. doi: 10.2106/JBJS.L.00432
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Abstract

Background: 

Ceramic femoral heads produce less wear of the opposing polyethylene than do metal femoral heads in wear simulation studies. This is a matched-pair analysis of the wear of ceramic and metal femoral heads on conventional polyethylene in uncemented total hip replacements in young, active patients at a minimum of fifteen years of follow-up.

Methods: 

From June 1989 to May 1992, thirty-one matched pairs of alumina ceramic or cobalt-chromium metal femoral heads were identified. Patients were matched on the basis of age, sex, body weight, diagnosis, and activity level. The mean age was 55 ± 9 years (range, twenty-three to sixty-five years) at the time of surgery. All procedures were performed with a posterolateral surgical approach by a single surgeon using press-fit Ranawat-Bernstein femoral stems, Harris-Galante-II acetabular cups, GUR 4150 conventional polyethylene (sterilized in argon), and 28-mm-diameter femoral heads. Wear measurements were performed by two independent observers using the computer-assisted Roman software.

Results: 

The average duration of follow-up was 17 ± 1.7 years (range, fifteen to twenty years). The mean Hospital for Special Surgery hip scores (and standard deviation) in the ceramic and metal groups were 39 ± 4 and 40 ± 3 at the time of final follow-up. The University of California Los Angeles activity score at the time of the final follow-up was 6 ± 2 for both groups. The mean wear rates for the ceramic group and the metal group were 0.086 ± 0.05 mm/yr and 0.137 ± 0.05 mm/yr, respectively (p = 0.0015). There was one reoperation in the ceramic group because of distal femoral osteolysis. There were three failures in the metal group, requiring isolated liner exchange in two hips and revision of the acetabular component in one hip because of wear-induced osteolysis and/or loosening that caused symptoms. Five hips in the ceramic group and six hips in the metal group had radiographic evidence of acetabular or femoral osteolysis, but none were symptomatic.

Conclusions: 

Ceramic femoral heads produced significantly less wear on conventional polyethylene liners at the time of long-term follow-up than did metal heads in this matched-pair analysis of young and active patients with uncemented fixation.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    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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    Hiromu Shoji, MD
    Posted on July 23, 2013
    Question on treatment of acetabular osteolysis in Fig.1-A & 1-B
    Loma Linda University, Loma Linda, CA, USA

    I enjoyed reading the article and wholeheartedly agree with the authors' conclusion and opinion on general superiority in ceramic on polyethylene articulation in terms of polyethylene wear. I have one question. In Fig. 1-A it states "the metal side was revised with a liner exchange fourteen years postoperatively for pain resulting from substantial osteolysis". In Fig. 1-B it appears that the liner and femoral head on the metal side were exchanged and the acetabular shell was left intact. It also appears that the extent of osteolysis is just about the same between Fig.1-A (before revision) and Fig.1-B (probably four years after revision). This observation of mine leads me to interpret that the authors did not directly address the pathology in the acetabulum itself during revision. If the revision was done for painful acetabular osteolysis, should a treatment of osteolysis be done by revising entire acetabular component? Is exchange of the liner and femoral head alone expected to be successful? Or did they do something on the pathology which I failed to discover in these Figures? I would appreciate the authors' response to my question.

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