Ceramic-on-ceramic implants in total hip arthroplasty

Alumina ceramic is an excellent material for biologic implantation. Decreased particulate wear debris should increase implant longevity. The purpose of this study is to examine clinical and radiological results of ceramic-on-ceramic hip implants compared to cobalt chrome on polyethylene. Four cementless systems were compared, three alumina-on-alumina bearing systems: System I, porous coated cup; System II, hydroxyapatite-coated cup; Trident system, hydroxyapatite-coated cup with metal sleeve backing on ceramic cup liner; and System III (control), porous-coated cup with polyethylene and cobalt chromium bearing system. Patients were randomized to receive System I, II, or III. Trident patients were not randomized. Examinations are performed at 6 months, 1 year and yearly thereafter including x-rays, clinical exam and Harris Hip Score (HHS). Minimum 24-month followup was performed in 562 ceramic hips and 154 control hips. Age, height, weight, gender and diagnosis were similar in all groups. HHS was rated good/excellent by 95 percent of ceramic hips and 97 percent of control hips. Radiographic results demonstrated radiolucency in Femoral Gruen Zone 1 in 3.8 percent (18/474) of ceramic hips and in 8 percent (10/128) of control hips. Unstable acetabular components were reported in none of ceramic hips and in 3.2 percent (5/154) of control hips. Revision was performed in 7 (1.2 percent) ceramic hips, none due to failure of ceramic materials, and in 9 (5.8 percent) control hips. Alumina ceramic materials show promise, but continued evaluation of long-term clinical results is needed.