A1223. 10 YEAR EXPERIENCE WITH CERAMIC-ON-CERAMIC TOTAL HIP ARTHROPLASTY

Abstract

Ceramic on ceramic articulations had been used since 1970s but with high failure rate.

More recent third generation alumina ceramic had improved results due to better material properties to resist wear and fracture and better methods of fixation with metal back acetabular components. A new clinical problem of squeaking has emerged in the last decade and is now a relatively common occurrence in ceramic on ceramic total hip arthroplasty, with a reported incidence from less than 1% to 20% depending on the definition of the noise. We report experience with over 3000 ceramic-on-ceramic hips including the 10 year minimum follow-up of the first 301 cases.

Methods: Between June 1997 and Feb 1999, 301 consecutive primary cementless hip arthroplasties were performed on 283 patients under the care of the two senior authors. The mean age of the patients was 58.

All patients are asked on follow-up as part of a questionnaire: Has your hip ever made a squeaking noise? To date of the more than 3000 ceramic on ceramic hips that we follow, 74 hips (71 patients) responded yes to this question. Patient demographic and outcome data were analysed in all squeaking hips and compared with all primary ceramic on ceramic hips operated on at our unit.

Results: Of the first 301 cases there have been 9 revision surgeries in 8 hips as follows.

Two acetabular components revised for psoas tendonitis, one of these subsequently had both components revised for acetabular osteolysis with femoral revision to improve anteversion.

There were six other femoral component revisions: four for periprosthetic femoral fractures, one for aseptic loosening and one for transient sciatic nerve palsy. There has been one squeaking hip in this group not requiring revision due to the mild and intermittent nature of the noise. All complications occurred within the first 3 years, no further complication has arisen since.

When comparing the 74 squeaking hips to the entire cohort of primary hips we found that taller, heavier and younger patients are significantly more likely to have hips that squeak.

Squeaking hips have a significantly higher range of post-operative movement than silent hips.

Squeaking hips have a significantly higher Harris hip score. There was no difference in the satisfaction scores between squeaking and silent hips.

Conclusion: In summary, we have reported the large series of third generation alumina ceramic on ceramic articulation with 10 year results, and have demonstrated that it can produce excellent survivorship with good clinical and radiographic outcome. We believe that this result had provided very encouraging evidence to support the use of third generation ceramics as articulation for primary hip arthroplasty, especially in young and active patients.