Abstract
INTRODUCTION
Young patients (< 50 years old) have been reported to have a higher risk of revision following total hip arthroplasty (THA) than older patient cohorts, possibly to due higher activity, a higher incidence of deformity and greater probability of 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
Between August 1999 and December 2007, 220 total hip arthroplasties in 191 patients under 50 years of age at the time of surgery were performed using alumina ceramic-ceramic bearings as part of a prospective, non-randomized 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 42.1 ±7.2 years (range: 17.4 years to 49.9 years), and the average time to follow-up was 10.1 ±2.4 years (range: 4.2 years to 15.2 years). We evaluated implant-related complications and performed Kaplan-Meier analyses to determine survivorship of the THA components with revision for any reason as the endpoint.
RESULTS
There were no dislocations or failures due to osteolysis or aseptic loosening. There was one patient death not related to the THA procedure. Through 15-years, the Kaplan-Meier survivorship of all components was 94.9% (CI: ±8.0) with 8 revisions (3.6%) of either the cup, the stem, or both. For the acetabular component, the 15-year survivorship was 97.0% (CI: ±6.1) and included 4 revisions (1.8%), and 98.1% (CI: ±1.9) for the femoral component including 4 revisions (1.8%). One patient had both the femoral and acetabular components revised. 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 (1.3%), and one acetabular component dislodged (0.4%) immediately following surgery. Two patients reported non-reproducible squeaking. One hip was revised at an outside institution for unknown reasons. Using the National Institutes for Health and Clinical Excellence (NICE) guidelines, our results are well within the 1% per year acceptable failure rate for this young patient population (acetabular components: 0.1% per year, femoral components: 0.1% per year, all revisions: 0.2% per year). From our experience, ceramic-on-ceramic THA in patients less than 50 years of age is very reliable with a low revision rate and absence of 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.
