Abstract
Introduction
Modern ceramic-on-ceramic bearings have become attractive alternatives to conventional polyethylene due to their low wear and minimal particle production. However, ceramic-on-ceramic implants have been associated with ceramic fracture and squeaking. To address these issues, large ceramic heads with a titanium-alloy sleeve have been introduced although limited data are available on their clinical outcomes. The purpose of this study was to report the midterm results of primary total hip arthroplasty using a 32mm with a titanium-alloy sleeve.
Materials & Methods
We reviewed 245 patients who had 274 total hip arthroplasties with a 32 mm ceramic head with a titanium-alloy sleeve and had been followed for more than 5 years (average, 6.5 years; range, 5–9 years). The mean patient age at the time of surgery was 55.1 years (range, 16–82 years). All operations were performed at a single center. All of the ceramic implants were hot isostatic pressed, laser-marked, proof-tested third-generation alumina (Fig. 1). We determined the implant survival, Harris hip scores, incidence of ceramic fracture or noisy hips, and presence of osteolysis.
Results
The survival rate of ceramic-on-ceramic bearings in primary total hip arthroplasty using 32 mm ceramic head with titanium-alloy sleeve was 97.5% at 9 years (Fig. 2). The Harris hip score improved from mean of 47 preoperatively to 93 at last follow-up. One ceramic head fractured at 6 years postoperatively. No ceramic liners were seen to fracture. Audible hip noise was identified in five hips (1.8%); clicking in four and squeaking in one. Osteolysis was detected in four hips (1.5%), but all had no symptom (Fig. 3). Other complications included three deep infections, two dislocations, and one peroneal nerve palsy.
Conclusions
Primary ceramic-on-ceramic total hip arthroplasty using a 32 mm ceramic head with a titanium-alloy sleeve has a high survival rate of 97.5% at a 9-year follow-up. Nevertheless, surgeons should be aware of the potential risks of ceramic fracture, noise, and osteolysis associated with the use of ceramic head with a titanium-alloy sleeve.
