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Uncemented total hip arthroplasty using alumina ceramic bearings at a minimum of 14 years of follow-up

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The effectiveness of modern ceramic bearings has been well established in reducing the osteolysis associated with wear of the bearing surfaces in total hip arthroplasty (THA). However, there are limited mid- to long-term follow-up data for complications associated with ceramic bearings.

Materials and methods

This case series analyzed 124 consecutive primary uncemented THAs in 108 patients with a mean age of 61 years using alumina ceramic-on-alumina ceramic bearing couples. Seventy THAs (56%) were evaluated at a minimum 14 years of follow-up; the mean follow-up period was 16 ± 1 years (14–20 years). Kaplan–Meier survivorship was determined with revision surgery for any reason as the end point. Complications were recorded focusing on osteolysis, ceramic fracture, and abnormal sounds until the final follow-up. Clinical data were scored according to the Merle d’Aubigne and Postel hip score at 14 years after THA.

Results

The survivorship was 93.5% (95% CI 86.7–97.0%) at 14-years postoperatively. Five patients (4.0%) underwent revision surgery due to instability or infection before 1-year postoperatively. Two patients (1.6%) underwent revision surgery due to ceramic liner fracture at 9- and 12-years postoperatively, respectively. There was no radiographic evidence of osteolysis. A total of 27 complications occurred: dislocations (n = 7/124), squeaking sounds (n = 3/124), clicking sounds (n = 6/124), ceramic liner fractures (n = 2/124), periprosthetic fractures (n = 4/124), deep infections (n = 2/124), transient sciatic nerve palsy (n = 2/124), and femoral stem breakage (n = 1/124). The Merle d’Aubigne and Postel hip score was 16.8 ± 1.4 points.

Conclusions

The survivorship analysis demonstrates the uncemented THA using alumina ceramic bearings may provide favorable clinical outcome and can offer minimal wear at a minimum 14-year follow-up. Revision surgery was mostly required due to instability and infection in the short-term, and implant breakage in the mid- to long-term.

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Acknowledgements

All authors declare no conflicts of interest and no funding was received for this study. The authors thank Masaki Ishizaka, MD of Ishizaka Orthopedic Clinic, Munenori Matsueda, MD of Niigata Central Hospital, and Naoki Takahashi, MD of Kido Hospital for help in following up the study patients. They also thank Minako Ooiwa, Yui Yamada, Sachika Hara, Ai Tanaka, Ayumi Taguchi and Mayumi Morita for their dedicated support in the study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo City, Niigata, 950-1151, Japan

    Sachiyuki Tsukada, Motohiro Wakui, Kazuha Kizaki, Takuya Iseki & Masunao Miyao

  2. Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan

    Sachiyuki Tsukada

  3. Department of Orthopaedic Surgery, St. Luke’s International Hospital, 9-1 Akashi Cho, Chuo City, Tokyo, 104-8560, Japan

    Atsushi Tasaki

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  1. Sachiyuki Tsukada
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  2. Motohiro Wakui
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Correspondence to Sachiyuki Tsukada.

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The study was initiated after receiving approval from the institutional review board.

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The requirement for informed consent was waived based on the decision of our institutional review board since this retrospective study did not include any intervention or any personally identifiable information.

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Tsukada, S., Wakui, M., Kizaki, K. et al. Uncemented total hip arthroplasty using alumina ceramic bearings at a minimum of 14 years of follow-up. Arch Orthop Trauma Surg 142, 1689–1695 (2022). https://doi.org/10.1007/s00402-021-04055-z

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