Comparison of 5-year cup and stem migration between ceramic-on-ceramic and ceramic-on-polyethylene bearing in press-fit total hip arthroplasty: a randomised controlled trial using radiostereometric analysis

Introduction: The inelasticity of ceramic bearings might affect primary stability and migration of implants in press-fit total hip arthroplasty (THA). This randomised controlled trial compares migration patterns of the uncemented Delta-TT cup and H-MAX S stem between ceramic and polyethylene liners, up to 5 years follow-up. Methods: Patients receiving primary press-fit THA were randomly allocated to a ceramic (n = 28) or polyethylene (n = 25) liner. Migration was measured using model-based radiostereometric analysis (RSA) at baseline and 1.5, 3, 6, 12, 24 and 60 months postoperatively and compared between groups using mixed models statistical analysis. The focus of this study is on the 2- to 5-year migration of the Delta-TT cup and migration during complete follow-up of the H-MAX S stem up to 5-years. Results: At 5-year follow-up, mean (95% CI) proximal cup translation was 0.56 (0.37-0.74) mm in ceramic and 0.58 (0.25-0.90) mm in polyethylene (p = 0.729). The mean change in adduction was 1.05 degrees (0.27-1.82 degrees) in ceramic and 0.78 degrees (-0.16-1.71 degrees) in polyethylene. Mixed modelling showed that all between-group effects were <= 0.20 mm for translation and 0.22 degrees for rotation at 5 years postoperatively (p >= 0.23). Mean cup migration between 2 and 5 years was limited (all parameters <0.17 mm and <0.30 degrees). At 5-year follow-up, mean stem subsidence was 2.09 mm (0.89-3.29 mm) in ceramic and 2.55 (0.97-4.12) mm in polyethylene. The mean change in internal rotation was 3.69 degrees (1.98-5.40 degrees) in ceramic and 4.01 degrees (2.20-5.81 degrees) in polyethylene. Most stem migration occurred up to 1.5 months, stabilising afterwards. All between-group effects were <= 0.75 mm for translations and <= 1.41 degrees for rotations (p >= 0.26). Conclusions: 5-year migration patterns of press-fit cups and stems were similar between ceramic and polyethylene liners. The Delta-TT cup and H-MAX S stem showed secondary stabilisation and remained stable up to 5 years in both groups, which is promising for long-term survival with both liner types.