Abstract
Introduction
In the year 1977 we started to use ceramic on ceramic total hip (Ceraver*). The prosthesis was cemented on both sides. Ceramic was medical grade with relative large grains and high porosity. The stem was made of titanium alloy smooth and oxidized.
In 1990 we published the results of 86 hips in 75 patients who were less than 50 years of age at time of operation (1). Recently we tried to reach the same patients, looking specifically to those who could have more than 20 or 30 years follow-up.
Material and methods
This study design included all patients operated between 1977 and 1986 and having less than 50 years of age at time of surgery. Eighty six hips in 75 patients, 34 females and 41 men. Mean age was 43 (from 18 to 50) nine had a BMI in excess. 66 hips were performed primaries while 20 consisted in revision procedure including 6 total hip revisions, 5 resurfacing, 4 single cup, 3 hemiarthroplasty, and 2 acetabula fractures. Four of these had a past history of infection. Preoperative diagnosis were secondary osteoarthritis in 41, AVN in 26, primary OA in 3, Rheumatoid arthritis in 12, tuberculosis in 2 and hemophilic in two.
Results
Complications: one early sepsis was cured by reoperation without material exchange, another septic case was revised at 2 years, 6 years later the results was poor and we could not trace him. One had a nonunion of the greater trochanter and one had one isolated dislocation. One presented with a fracture of an extra small ceramic head of 22 mm in diameter for high Crowe 4 DDH. The broken head was replaced by a metallic head and the socket by a polyethylene one.
We tried to reach every patient and did separate them in four groups:
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13 hips in 12 patients that were not followed more than 2 years: they usually leaved in Africa (Algeria, Ivory Coast or Senegal and could not be traced),
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6 deceased from one to 28 years after index procedure, with no relation with their hip still in place.
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A group of 25 hips in 22 patients that were reached recently (some are still followed some were found by Google and reached by phone), and had not been revised. One of these had a fractured head at 21 years.
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The last group consisted in 49 hips in 48 patients who were followed for periods from 2 to 20 years. Four of these were revised always for socket loosening at period from 12 to 18 years. No reoperation for stem loosening. The revision consisted in socket exchange for a press fit material with a ceramic liner.
As in our first study we identified some cases that presented with radiolucent lines at the socket side, we found no correlation between this aspects and the risk of revision.
We worked more precisely on the group of 22 patients effectively followed more than 20 years, 10 more than 30 years. They had no limitation on the operated hip; some are still performing heavy activities including sports; they have no complain about noise. Slight pain was noticed in two of them.
Conclusion
We found an extremely good results; no degradation of the hip clinically nor radiographic. Some radiolucent lines are still visible but not harmful. The most intriguing aspect is the total absence of osteolytic lesions. With a contemporary material implanted since 15 years we suppose to avoid some of the complications observed in this first trial group.
