Third-Generation Alumina-on-Alumina Total Hip Arthroplasty: 14 to 16-Year Follow-Up Study

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Abstract

Ceramic-on-ceramic articulation has the lowest wear with little osteolysis. However, the wear and osteolysis in long-term follow-up are not known. Another concern is ceramic fracture, which might occur after repeated stress during a long period. Ninety hips (76 patients with a mean age of 47 years) that underwent cementless total hip arthroplasty using third-generation ceramic-on-ceramic articulation were followed for 14–16 years. At final follow-up, there was no measurable ceramic wear and no periprosthetic osteolysis was identified. No ceramic fracture occurred during the follow-up. One hip was revised because of late infection. All prostheses were bone-ingrown. Two patients experienced a grinding sensation. However, no patient had squeak. The mean Harris hip score at the final evaluation was 89 points and the survival rate was 98.9%.

Section snippets

Materials and Methods

Between February 1998 and February 2000, 108 primary THAs were performed at the author’s hospital. Among them 104 THAs (89 patients) were performed using a single cementless prosthesis design with alumina-on-alumina articulation. In the remaining 4 patients (4 hips) with small femoral dimensions, that prosthesis could not be used. These 4 patients underwent THA with other prosthesis and were excluded from the study.

Five patients (5 hips) were not followed for a minimum of 14 years. Eight

Results

The three femoral fractures, which occurred during insertion of the stem, healed completely, and osseointegration of the prosthesis was achieved. Two hips dislocated after a stumble at postoperative 5 days and 3 weeks, respectively. They were treated successfully with closed reduction and abduction bracing for 3 months, after which, there was no recurrence.

One patient sustained a periprosthetic fracture after falling from a height of 3 m at 9 years postoperatively. The fracture occurred just distal

Discussion

This is the first report on the 15-year follow-up results of THA with the use of a contemporary alumina-on-alumina articulation. We limited our subjects to patients who were followed for 14 to 16 years. In the current follow-up, there was no detectable wear, osteolysis or prosthetic loosening and the survival rate was 98.9%.

The COC articulation has been used for THA during more than 40 years. Since 1990, mechanical properties of alumina have been substantially improved. The third generation

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    Level of evidence: therapeutic study, level IV.

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.09.020.

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