Large bearing surfaces are appealing in total hip arthroplasty (THA) as they may help create a greater range of impingement free motion and reduce the risk of dislocation. However, attempts to achieve this with a metal bearing surface have been blighted by adverse reactions to metal debris. Ceramic bearings have a good long-term track record in more conventional head sizes, and manufacturing techniques now permit the use of larger ceramic bearing surfaces using monoblock uncemented acetabular components. In this study, we are reviewing the early results of the Maxera® acetabular component (Zimmer, Indiana) at our institution.

All data was collected prospectively. Maxera® acetabular component is a Titanium (Ti) shell with plasma sprayed Ti for the osteointegrative surface. Delta ceramic liner is inserted & locked into the cup shell by the manufacturer (non-modular). With the Maxera cup system, the bearing diameter is dictated by the acetabular component size. Acetabular components (AC) of 46 and 48 mm have a bearing diameter (BD) of 36 mm, AC of 50 and 52 mm: have a 40 mm BD, AC of 54 and 56 mm: have a BD of 44 mm and AC of 58–64: have a 48mm BD. Delta ceramic femoral head size of 44 and 48 mm have a modular Ti sleeve between the head and femoral stem trunnion. Femoral head sizes of 36 and 40 mm have no Ti sleeve. All THA had an uncemented femoral stem. Implants were inserted with a posterior approach. Patients were reviewed at 6 weeks, 6 months and then annually with radiographs. Clinical function was evaluated using WOMAC and UCLA scores along with joint perception questionnaires.

Five hundred components have been implanted in 442 patients (250 women, 192 men) with a mean age of 55, (min 17, max 80) and a mean BMI of 26.9 (min 17.8, max 51). The mean acetabular size was 54 (min 46, max 64), leading to a mean femoral head size of 44. At a minimum of two years follow-up (mean 3.8 years): 5 patients have been revised, 4 secondary to undetected intraoperative fracture of the femur and only one due to early displacement of a Maxera® cup (0.2%). Five patients reported a mild squeaking; two reported clicking and one patient presented with a symptomatic heterotopic ossification. The WOMAC score improved significantly post-operatively, (57.4 compared to 4.4 post-operatively, p<0.001). The mean post-operative UCLA score was 6.9. Sixty percent (60.6%) of patients rated their joint perception as either “natural” or “artificial without limitation”. two patients (0.4%) suffered a dislocation after high velocity trauma without recurrence after closed reduction. No ceramic component fracture was recorded.

This prospective study shows that this monoblock acetabular component provides an easy implantation with minimal complications. The ceramic bearing surface provides good clinical function and joint perception. Bearing surfaces of this design may provide an alternative to large head metal on metal (MoM) implants without the side effects of metal debris/ions.