Abstract
Introduction and Aims: Third generation alumina ceramic-on-ceramic bearings are being increasingly used in hip replacement surgery as an alternative to polyethylene because of the unacceptably high wear of polyethylene bearings and associated osteolysis leading to failure of hip replacement. Follow-up time with these modern ceramic bearings is still short.
Method: We report the minimum five-year follow-up of our first 300 hip replacements with these bearings in 283 patients, done between June 1997 and February 1999. Three hundred ceramic-on-ceramic Osteonics Securfit or Securfit Plus stems were used with the Osteonics Securfit cup in all cases – these are cement-free and hydroxyapatite coated. The bearings were third generation alumina ceramic femoral heads and cup inserts manufactured by CeramTec. The average age was 58 years and there were 52% females. Osteoarthritis was the diagnosis in 93% and inflammatory arthritis in four percent. We used 92% 32mm bearings and eight percent 28mm bearings.
Results: Mean Harris hip score improved from 56 pre-operatively to 94 at five years. Complications included: three non-fatal and no fatal pulmonary emboli, one deep and four superficial infections. There were four revisions for periprosthetic femoral fracture, one for cup malposition and one for sciatic nerve palsy in a patient with proximal focal femoral deficiency. There were a further four re-operations for psoas tendonitis where the psoas tendon was released. There were no re-operations for bearing failure and none of the ceramic components failed catastrophically, although a small number of acetabular inserts chipped around the rim during insert and were discarded. Of particular interest is the fact that there was no osteolysis seen in any of these hips, either around the acetabulum or around the femur. The usual small lytic areas noted around the calcar and the trochanteric regions of the femur that are commonly seen with polyethylene bearings were completely absent in this group. Three of the hips squeak intermittently with vigorous activity.
Conclusion: Third generation ceramic-on-ceramic bearings have only been available for seven or eight years. Early results using these new bearings are encouraging, in that osteolysis to date has not been seen in this series. No hip in this series has been revised for failure of these ceramic implants. It will be a further five to 10 years before we can be certain how these newer bearings will perform in the long term, but the five-year results are encouraging.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
