Introduction: Ceramics appear to be good material for bearing surfaces due to their extreme hardness. We present the follow up results on 726 Total Hip Replacements using ceramics done in an institution over 19 years.

Patients and methods: This is a single surgeon series of 836 total hip replacements using ceramic as a bearing surface, performed since 1981. 283 of these were ceramic on ceramic whereas 408 were ceramic on polyethylene, most inserted without cement. 726 (86.9%) of these patients were either examined (546) or assessed with a questionnaire (149). 31 patients had died and their dates of death were taken as the point in time when their hips were surviving. These three groups are included in the analysis. 43 of the hips were revised. A survivorship analysis – using the life table technique – of the two groups was performed using revision as the end point.

Results: 31 total ceramics, and 12 ceramic-on-polyethylene hips required revision. The survivorship illustrated a superior performance of the ceramic-on-polyethylene implants.

Discussion: The patients in the total ceramic group were considerably younger (average age 34.7) compared to the ceramic on polyethylene group (average age 59.2). Seven patients with failed implants from the ceramic-on-ceramic group had been subjected to previous surgery compared to only one in the other group. The majority of the ceramic-on-ceramic group had a primary pathology more likely to cause a distorted anatomy of the hip joint. In general the patients in the total ceramic group were at higher risk of failure for technical reasons. The follow up period – mean 9.23 years for the total ceramic group, and 8.22 years for the ceramic-on-polyethylene group – is relatively short, and future years will further clarify the situation.