Fracture risks are the most common argument against the use of Ceramic on ceramic (CoC) hip implants. Question: is ceramic material at risk in case of severe local trauma?

Over a long period, we tried to identify patients with a CoC prosthesis (Ceraver Osteal°)who did sustain a trauma. This was conducted in three different institutions.

Eleven patients were found: 9 males and 2 females aged 17 to 70 years at time of index surgery. Accident occurred 6 months to 15 years after index: one car accident, five motorcycle accident, five significant trauma after a fall, including one ski board accident. Consequences of these trauma were: six fractures of the acetabulum with socket loosening in 4 that needed revision, two femoral shaft fracture, one orifed and one stem exchanged, one traumatic hip dislocation associated to loosening of the socket revised at 10 years, and one traumatic loosening of the socket. Ten had no consequence on ceramic integrity. One experienced a fracture of the patella from a dashboard trauma, a liner shipping was discovered during socket revision 2 years later. This is the only case of possible relation between trauma and ceramic fracture. In a more recent longitudinal study on 1856 CoC prosthesis performed from 2010 to 2021, 29 severe traumas were identified with no consequence on Ceramic material.

From this limited case study, it can be assumed that Pure Alumina Ceramic well designed and manufactured, will not break after a significant trauma.

We assessed the clinical and radiological outcome of a single uncemented total hip replacement (THR) after twenty years, analysing polyethylene wear and osteolysis.

82 hips implanted between 1992 and 1995 were prospectively evaluated. Mean follow-up was 20.6 years (18–23). A hemispherical porous-coated cup matched to a proximally hydroxyapatite-coated anatomic stem. A 28mm PE liner, sterilised by gamma irradiation in air, was used in all hips. Radiological position, eventual loosening and osteolysis were recorded over time. Penetration of the head into the liner was measured by the Roentgen Monographic Analysis (ROMAN) Tool at 6 weeks, 6 months, one year and yearly thereafter.

Six cups were revised due to wear and four cups because of late dislocation. All stems showed osseointegration and all cups appeared radiographically well-fixed. Six unrevised hips showed osteolysis on the acetabular side and two hips on the proximal femur. Creep at one year was 0.30±0.23 mm. Mean total femoral head penetration was 1.23mm at ten years, 1.52mm at 15 years and 1.92mm at 23 years. Overall mean wear was 0.12±0.1 mm/year and 0.09±0.06 mm/year after the creep period. Mean wear was 0.08±0.06 mm/year in hips without osteolysis and 0.14±0.03 mm/year in hips revised or hips with osteolysis (p<0.001).

Although continued durable fixation can be observed with porous-coated cups and proximally hydroxyapatite-coated anatomic stems, true wear continues to increase at a constant level over time. PE wear remains as the main reason for osteolysis and revision surgery in uncemented THR after twenty years.

Different pathologies, deformities, bone defects, previous surgeries and polyethylene wear limit the survival of total hip arthroplasty (THA) in young patients. We compare preoperative status and outcome in 171 young and very young patients (207 hips) who underwent a ceramic-on-ceramic THA. Sixty-three (77 hips) were less than 30 years old (group 1) and 108 (130) were between 30 and 40 years old. Mean follow-up was 11.3 years. Two-way ANOVA with repeated measures were used to analyse clinical and radiological changes.

Juvenile rheumatoid arthritis (JRA) was the most frequent diagnosis in group 1 and avascular necrosis in group 2. Charnley class type C, low activivity, previous surgery and osteoporotic bone were more frequent in group 1 patients. There were 2 cup revisions for aseptic loosening in group 1 and 4 in group 2. Survivorship analysis at 15 years was 96.7% (95% IC 92.2 a 100) for group 1 and 96.1% (95% IC 92.2 to 100) for group 2 (p=0.749). Despite the worse preoperative status in group 1 patients, clinical outcome was similar in both groups. Severe dysplasia had the worst clinical result and avascular necrosis the best. Patients with Charnley class C and JRA showed the most improvement. Radiographic reconstruction of the abduction angle was worse in group 1 (p=0.02). No osteolysis or complications derived from ceramic use were found.

We conclude that despite the worse preoperative status in group 1 patients, clinical and radiographic results were good in both groups of patients who received a ceramic-on-ceramic THA.