Alumina ceramic-on-ceramic hybrid total hip arthroplasty. A median of 15 years follow-up

Abstract

The optimum choice of bearing surfaces in total hip replacement (THR) in the younger and active patient remains controversial. The aim of this study was to report the 10year clinical outcomes, and a median of 15year implant survival and incidence of complications in a series of Alumina ceramic-on-ceramic THRs utilising an uncemented shell and cemented stem. From January 2004 to December 2007, 175 consecutive patients (195 hips) underwent primary THR. The acetabular components was Trident Peripheral Self Locking (Stryker Orthopaedics) with a third-generation ceramic head and liner (Alumina ceramic, Stryker Orthopaedics). The stem utilised was an Exeter V-40 (Stryker Orthopaedics). Data were collated on demographics, surgical factors, clinical outcomes, radiographic outcomes and revision. 23 patients (27 THRs) died during the follow-up period at a median of 7.8 (3.8 to 9.0) years post-operatively due to causes unrelated to the THR. Median age at time of surgery was 55 (interquartile range 48-60) years. Median follow-up for surviving patients was 15.2years. Survivorship for all-cause revision was 97.2%. Increasing patient age at time of surgery was associated with a higher OHS at 10years (p = 0.022). 32mm head diameter had an improved OHS at 3months (p = 0.014) and 10years (p = 0.030). Posterior surgical approach had a statistically significant better OHS at 3months (p = 0.015) and 1year (p < 0.001), but the effect was not significant at 10years (p = 0.440). The findings of this study support excellent long-term outcomes and survivorship of Alumina ceramic-on-ceramic bearing in a hybrid THR in a younger population. Surgical factors leading to a more favourable outcome were the use of a 32mm femoral head and a posterior approach. Increasing age at surgery demonstrated the most sustained improvement in 10year clinical outcomes.