Abstract
Introduction
The success of total hip arthroplasty has meant its indications have been extended to the younger more active patient. Due to the higher activity levels and increased demands of these patients, revision rates have been traditionally higher than when compared to older patients [1]. Ceramic on ceramic bearings may offer a viable long term solution as manufacturing methods have evolved resulting in improved mechanical properties, particularly of third and fourth generation ceramics. We report the outcome of primary cementless, alumina-on-alumina hip arthroplasty with a minimum 10 year follow up in 110 patients under the age of 55 years of age at time of surgery.
Methods
A series of 120 consecutive total hip arthroplasties in 110 patients were performed between June 1997 and February 1999 by the two senior authors. All patients had an Osteonics ABC acetabular component and SecurFit or SecurFit Plus femoral component (Stryker Orthopaedics, Mahwah, NJ) with an alumina C-taper ceramic head (Biolox Forte, Ceramtec, Plochingen, Germany).
Results
Of the 110 patients originally in the study, 4 (3.6%) patients died, 6 (5%) were lost to follow up and 4 hips (3.6%) were revised by the time of the latest follow up. Clinical information was available for 106 hips in 96 surviving patients at a minimum of ten years of follow-up, and radiographic information was available for 90 hips from the same 96 patients. The mean follow up was 11.5 years (range 10 to 13.5 years). Survivorship analysis with revision for any reason as an endpoint was 96.5% at 10 years (CI 94.5% −98.7%) using the Kaplan-Meier method. Modified mean UCLA scores improved from 6.4 (range 4 to 10) pre operatively to 9 (range 4 to 10) at latest follow up. The mean Harris Hip Score improved from 53.4 points (range 15 to 86) preoperatively, to 94.7 points (range 63 to 100) at latest follow up.
All femoral stems had stable bone ingrowth, with no migration. Osteolysis was not observed around the femoral or acetabular components and there were no signs of radiological wear. 98 patients (92.4%) managed to continue with their current occupations during the follow up period whilst 5 patients (4.7%) changed occupation to work that required increased activity. Complications included 3 cases of iliopsoas tendonitis, 2 cases of squeaking, a ceramic liner chipping during insertion and sciatic nerve palsy. There were no cases of ceramic fracture in this younger, active cohort of patients. No evidence of bearing failure was demonstrated nor any signs of adverse reaction to wear debris.
Conclusions
Alumina ceramic on ceramic bearings in cementless primary total hip arthroplasty show good clinical and radiological outcomes in the higher demand younger age patient. Based on these results we now support heavy occupational work and regular impact sports in these patients once they have recovered from surgery.
