Skip to main content

Advertisement

SpringerLink
Log in

Alumina ceramic-on-ceramic hybrid total hip arthroplasty. A median of 15 years follow-up

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The optimum choice of bearing surfaces in total hip replacement (THR) in the younger and active patient remains controversial. The aim of this study was to report the 10 year clinical outcomes, and a median of 15 year implant survival and incidence of complications in a series of Alumina ceramic-on-ceramic THRs utilising an uncemented shell and cemented stem.

Methods

From January 2004 to December 2007, 175 consecutive patients (195 hips) underwent primary THR. The acetabular components was Trident Peripheral Self Locking (Stryker Orthopaedics) with a third-generation ceramic head and liner (Alumina ceramic, Stryker Orthopaedics). The stem utilised was an Exeter V-40 (Stryker Orthopaedics). Data were collated on demographics, surgical factors, clinical outcomes, radiographic outcomes and revision.

Results

23 patients (27 THRs) died during the follow-up period at a median of 7.8 (3.8 to 9.0) years post-operatively due to causes unrelated to the THR. Median age at time of surgery was 55 (interquartile range 48–60) years. Median follow-up for surviving patients was 15.2 years. Survivorship for all-cause revision was 97.2%. Increasing patient age at time of surgery was associated with a higher OHS at 10 years (p = 0.022). 32 mm head diameter had an improved OHS at 3 months (p = 0.014) and 10 years (p = 0.030). Posterior surgical approach had a statistically significant better OHS at 3 months (p = 0.015) and 1 year (p < 0.001), but the effect was not significant at 10 years (p = 0.440).

Conclusion

The findings of this study support excellent long-term outcomes and survivorship of Alumina ceramic-on-ceramic bearing in a hybrid THR in a younger population. Surgical factors leading to a more favourable outcome were the use of a 32 mm femoral head and a posterior approach. Increasing age at surgery demonstrated the most sustained improvement in 10 year clinical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Data are available on request.

Code availability

Not applicable.

References

  1. National Joint registry Editorial board and contributors. 17th Annual report. 2020 [Cited 1st Oct 2020]. Available from: https://reports.njrcentre.org.uk/Portals/0/PDFdownloads

  2. Kahlenberg CA, Swarup I, Krell EC, Heinz N, Figgie MP (2019) Causes of revision in young patients undergoing total hip arthroplasty. J Arthroplast 34(7):1435–1440. https://doi.org/10.1016/j.arth.2019.03.014

    Article  Google Scholar 

  3. Metcalfe D, Peterson N, Wilkinson JM, Perry DC (2018) Temporal trends and survivorship of total hip arthroplasty in very young patients: a study using the National Joint Registry data set. Bone Joint J 100-B(10):1320–1329. https://doi.org/10.1302/0301-620X.100B10.BJJ-2017-1441.R2

    Article  CAS  PubMed  Google Scholar 

  4. Boyer B, Bordini B, Caputo D, Neri T, Stea S, Toni A (2019) What are the influencing factors on hip and knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties [published correction appears in Orthop Traumatol Surg Res. 2020 Feb;106(1):209]. Orthop Traumatol Surg Res 105(7):1251–1256. https://doi.org/10.1016/j.otsr.2019.07.020

  5. Santaguida PL, Hawker GA, Hudak PL et al (2008) Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg 51(6):428–436

    PubMed  PubMed Central  Google Scholar 

  6. Jeffers JR, Walter WL (2012) Ceramic-on-ceramic bearings in hip arthroplasty: state of the art and the future. J Bone Joint Surg [Br] 94-B:735–745

    Article  Google Scholar 

  7. Willmann G (2000) Ceramic femoral head retrieval data. Clin Orthop Relat Res 379:22–8

    Article  Google Scholar 

  8. Stafford GH, Islam SU, Witt JD (2011) Early to mid-term results of ceramic-on-ceramic total hip replacement: analysis of bearing-surface-related complications. J Bone Joint Surg [Br] 93-B:1017–1020

    Article  Google Scholar 

  9. Sexton SA, Yeung E, Jackson MP, Rajaratnam S, Martell JM, Walter WL, Zicat BA, Walter WK (2011) The role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements. J Bone Joint Surg-Br 93B:439–442

    Article  Google Scholar 

  10. Parvizi J, Bahar A, Wong JC, Restrepo C, Rothman RH (2011) A squeaky reputation: the problem may be design-dependant. Clin Orthop Relat Res 469:1589–605

    Article  Google Scholar 

  11. Restrepo C, Post ZD, Kai B, Hozack WJ (2010) The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty. J Bone Joint Surg Am 92:550–557

    Article  Google Scholar 

  12. Burgo FJ, Mengelle DE, Ozols A, Fernandez C, Autorino CM (2016) The damping effect of cement as a potential mitigation factor of squeaking in ceramic-on-ceramic total hip arthroplasty. Bone Joint Res 5(11):531–537. https://doi.org/10.1302/2046-3758.511.BJR-2016-0058.R1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Barrack RL, Mulroy RD Jr, Harris WH (1992) Improved cementing techniques and femoral component loosening in young patients with hip arthroplastyA 12-year radiographic review. J Bone Joint Surg Br 74(3):385–389

    Article  CAS  Google Scholar 

  14. Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27

    Google Scholar 

  15. DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32

    Google Scholar 

  16. Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Jr Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 55:1629–1632

    Article  CAS  Google Scholar 

  17. Mittelmeier H, Heisel J (1992) Sixteen-years’ experience with ceramic hip prostheses. Clin Orthop Relat Res 282:64–72

    Article  Google Scholar 

  18. O’Leary JF, Mallory TH, Kraus TJ, Lombardi AV Jr, Lye CL (1988) Mittelmeier ceramic total hip arthroplasty. A retrospective study. J Arthroplast 3(1):87–96. https://doi.org/10.1016/s0883-5403(88)80057-3

    Article  CAS  Google Scholar 

  19. Hannouche D, Nich C, Bizot P, Meunier A, Nizard R, Sedel L (2003) Fractures of ceramic bearings: history and present status. Clin Orthop Relat Res 417:19–26. https://doi.org/10.1097/01.blo.0000096806.78689.50

    Article  Google Scholar 

  20. Heck DA, Partridge CM, Reuben JD, Lanzer WL, Lewis CG, Keating EM (1995) Prosthetic component failures in hip arthroplasty surgery. J Arthroplast 10(5):575–580. https://doi.org/10.1016/s0883-5403(05)80199-8

    Article  CAS  Google Scholar 

  21. Howard DP, Wall PDH, Fernandez MA, Parsons H, Howard PW (2017) Ceramic-on-ceramic bearing fractures in total hip arthroplasty: an analysis of data from the National Joint Registry. Bone Joint J 99-B(8):1012–1019. https://doi.org/10.1302/0301-620X.99B8.BJJ-2017-0019.R1

    Article  CAS  PubMed  Google Scholar 

  22. Clarke IC, Good V, Williams P et al (2000) Ultra-low wear rates for rigid-on-rigid bearings in total hip replacements. Proc Inst Mech Eng H 214(4):331–347. https://doi.org/10.1243/0954411001535381

    Article  CAS  PubMed  Google Scholar 

  23. Kim YH, Kim JS, Park JW, Joo JH (2012) Periacetabular osteolysis is the problem in contemporary total hip arthroplasty in young patients. J Arthroplast 27(1):74–81. https://doi.org/10.1016/j.arth.2011.03.022

    Article  Google Scholar 

  24. Ho JH, Leikin JB, Dargan PI, Archer JRH, Wood DM, Brent J (2017) Metal-on-metal hip joint prostheses: a retrospective case series investigating the association of systemic toxicity with serum cobalt and chromium concentrations. J Med Toxicol 13(4):321–328. https://doi.org/10.1007/s13181-017-0629-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. D’Antonio JA, Capello WN, Manley MT, Naughton M, Sutton K (2005) A titanium-encased alumina ceramic bearing for total hip arthroplasty: 3- to 5-year results. Clin Orthop Relat Res 441:151–158. https://doi.org/10.1097/01.blo.0000194084.67364.6c

    Article  PubMed  Google Scholar 

  26. Miller AN, Su EP, Bostrom MPG et al (2009) Incidence of Ceramic Liner Malseating in Trident® Acetabular Shell. Clin Orthop Relat Res 467:1552–1556. https://doi.org/10.1007/s11999-009-0770-5

    Article  PubMed  PubMed Central  Google Scholar 

  27. Higuchi Y, Seki T, Takegami Y, Osawa Y, Kusano T, Ishiguro N (2019) What factors predict ceramic liner malseating after ceramic-on-ceramic total hip arthroplasty? Orthop Traumatol Surg Res 105(3):453–459. https://doi.org/10.1016/j.otsr.2019.01.009

    Article  PubMed  Google Scholar 

  28. Howie DW, Neale SD, Haynes DR et al (2013) Periprosthetic osteolysis after total hip replacement: molecular pathology and clinical management. Inflammopharmacology 21(6):389–396. https://doi.org/10.1007/s10787-013-0192-6

    Article  PubMed  Google Scholar 

  29. Savarino L, Baldini N, Ciapetti G, Pellacani A, Giunti A (2009) Is wear debris responsible for failure in alumina-on-alumina implants? Acta Orthop 80(2):162–167. https://doi.org/10.3109/17453670902876730

    Article  PubMed  PubMed Central  Google Scholar 

  30. Radl R, Hungerford M, Materna W, Rehak P, Windhager R (2005) Higher failure rate and stem migration of an uncemented femoral component in patients with femoral head osteonecrosis than in patients with osteoarthrosis. Acta Orthop 76(1):49–55. https://doi.org/10.1080/00016470510030319

    Article  PubMed  Google Scholar 

  31. Dudkiewicz I, Covo A, Salai M, Israeli A, Amit Y, Chechik A (2004) Total hip arthroplasty after avascular necrosis of the femoral head: does etiology affect the results? Arch Orthop Trauma Surg 124(2):82–85. https://doi.org/10.1007/s00402-003-0630-9

    Article  PubMed  Google Scholar 

  32. Çatma FM, Öztürk A, Ünlü S, Ersan Ö, Altay M (2017) Posterior hip approach yields better functional results vis-à-vis anterolateral approach in total hip arthroplasty for patients with severe hip dysplasia: A prospective randomized controlled clinical study. J Orthop Surg (Hong Kong) 25(2):2309499017717179. https://doi.org/10.1177/2309499017717179

    Article  Google Scholar 

  33. Robinson PG, Anthony I, Kumar S, Jones B, Stark A, Ingram R (2016) Noise characteristics in ceramic-on-ceramic vs. metal-on-polyethylene total hip arthroplasty: a comparative study. Hip Int 26(5):492–497. https://doi.org/10.5301/hipint.5000383

    Article  PubMed  Google Scholar 

  34. Keurentjes JC, Kuipers RM, Wever DJ, Schreurs BW (2008) High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res 466(6):1438–1443. https://doi.org/10.1007/s11999-008-0177-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Schroder D, Bornstein L, Bostrom MP, Nestor BJ, Padgett DE, Westrich GH (2011) Ceramic-on-ceramic total hip arthroplasty: incidence of instability and noise. Clin Orthop Relat Res 469(2):437–442. https://doi.org/10.1007/s11999-010-1574-3

    Article  PubMed  Google Scholar 

  36. Restrepo C, Matar WY, Parvizi J, Rothman RH, Hozack WJ (2010) Natural history of squeaking after total hip arthroplasty. Clin Orthop Relat Res 468(9):2340–2345. https://doi.org/10.1007/s11999-009-1223-x

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding was received for this research project.

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK

    Omer M. H. Farhan-Alanie, Alex Hrycaiczuk, Bryn Jones, Andrew Stark & Kevin Bryceland

  2. Department of Trauma and Orthopaedic Surgery, Forth Valley Royal Hospital, Stirling Rd, Larbert, FK5 4WR, UK

    Craig Tinning

Authors
  1. Omer M. H. Farhan-Alanie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alex Hrycaiczuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Craig Tinning
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bryn Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Stark
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kevin Bryceland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Omer M. H. Farhan-Alanie.

Ethics declarations

Conflicts of interest

There are no conflicts of interest to declare.

Ethics approval

Ethical approval was received by the regional ethical committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farhan-Alanie, O.M.H., Hrycaiczuk, A., Tinning, C. et al. Alumina ceramic-on-ceramic hybrid total hip arthroplasty. A median of 15 years follow-up. Eur J Orthop Surg Traumatol 32, 1127–1136 (2022). https://doi.org/10.1007/s00590-021-03087-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-021-03087-w

Keywords

Search

Navigation