Abstract
Introduction:
Young patients have been reported to have a higher risk of revision following total hip arthroplasty (THA) than older cohorts, possibly to due higher activity and a higher incidence of deformity and prior surgery. Ceramic-on-ceramic bearing surfaces have been proposed for use in young and active individuals due to their low wear, low risk of adverse biologic reaction, and long-term survivorship. We assessed the clinical results and long-term survivorship of uncemented ceramic-on-ceramic THA in a young patient population.
Methods:
341 total hip arthroplasties in 218 patients under 50 years of age at the time of surgery were performed were performed using alumina ceramic-on-ceramic bearings from August 1999 to April 2009 as part of a prospective nonrandomized study. All patients received uncemented acetabular components with flush-mounted acetabular liners using an 18 degree taper and uncemented femoral components. The average patient age at the time of surgery was 41.7 years (range 17.8–49.9 years). The minimum follow-up time was 2 years, (mean 9.1, range 2–13.9). We evaluated implant-related complications and performed Kaplan-Meier analyses to determine survivorship of the femoral and acetabular components with revision for any reason as the endpoint.
Results:
There were no dislocations or failures due to osteolysis or aseptic loosening. The 13-year survivorship of all components was 95.9% (CI 91.0–98.2). The 13-year survivorship was 97.4% (CI 92.3–99.1) for the acetabular component and 98.5% (CI 95.3–99.5) for the femoral component. There were two liner fractures (0.59%) and one head fracture (0.3%), two of which were sustained as a result of a fall from significant height. There were three failures of osseointegration (0.88%), and one acetabular component dislodged (0.3%) immediately following surgery. Two patients reported nonreproducible squeaking. One hip was revised at an outside institution for unknown reasons. In conclusion, ceramic-on-ceramic THA in the young patient population is very reliable with a low revision rate and absence wear-related osteolysis. Component fracture typically occurs with high-energy trauma, and squeaking occurrence is rare in the flush-mounted ceramic liners used in our study.
Conclusion
Total hip arthroplasty in young patients demonstrates excellent survivorship when uncemented titanium implants are coupled with ceramic-ceramic bearings.
