Long-term follow-up shows satisfactory outcomes with uncemented alumina ceramic-on-ceramic THA

Petsatodis GE. J Bone Joint Surg Am. 2010;92:639-644.

A retrospective study by Greek investigators shows satisfactory results with uncemented alumina ceramic-on-ceramic total hip arthroplasty at a minimum follow-up of 20 years.

The investigators reported six revisions in six patients which were performed for aseptic loosening and focal osteolysis. The investigators concluded that even better long-term results may occur when using more contemporary total hip arthroplasty (THA) implant designs and the current generation of ceramic-on-ceramic bearing surfaces.

For their study, George E. Petsatodis, MD, and colleagues sought to evaluate the performance of 109 alumina ceramic-on-ceramic THA bearings that were implanted between January 1985 and December 1989 during primary cementless THAs performed in 100 patients. The main indications for THA were congenital hip disease (48%), osteonecrosis (27%) and primary osteoarthritis (18%).

The investigators evaluated the patients’ functional outcome using the Charnley modification of the Merle d’Aubigné-Postel scale. At an average follow-up of 20.8 years, the investigators were able to re-evaluate 78 patients who had 85 of the THA procedures.

At their final follow-up, the patients had an average age of 66.8 years. Based on the Merle d’Aubigné-Postel score, 68% of hips were rated as excellent, 19% were good, 9% were fair and 4% were poor. The patients’ mean scores improved from 7.9 points preoperatively to 16.9 points at the last postoperative evaluation.

The cumulative Kaplan-Meier survival rate reached 84.4% at the 20.8 year follow-up, according to the study abstract.

This is a well done follow-up study of 100 patients (average age 46 years with a first-generation ceramic bearing). It clearly documents the excellent wear characteristics of that bearing material with no ceramic fractures and no radiographic evidence of wear. Our work with an improved ceramic material and more reliable implants at 10 years shows similar excellent results with regards to the bearing surface.

This paper reinforces our thinking that ceramic/ceramic bearings are an excellent option for young active patients. Given the improvements in ceramic materials and the advances in implant fixation, one should expect these constructs to last many decades.

– William N. Capello, MD
Professor Emeritus of Orthopedic Surgery
Indiana University School of Medicine
Indianapolis