Abstract
BackgroundUsing data from the Korean Hip Registry, we aimed to investigate mid-term clinical and radiographic outcomes, including the prevalence of periprosthetic joint infection (PJI), osteolysis, and component loosening or dislocation, and to analyze the incidence of bearing-related complications following modern ceramic-on-ceramic (COC) total hip arthroplasty (THA) using a single cementless hip system.MethodsFour hundred eighty-two patients (602 hips) who underwent Forte or Delta COC THAs with a single hip system and had a minimum 5-year follow-up were identified. The sample included 243 (50.4%) women and 239 (49.6%) men with a mean age of 50.6 years (range: 18–83 years). The Forte group comprised 310 hips, and the Delta group comprised 292 hips. The mean follow-up was 6.1 years (range: 5–10.2 years).ResultsCup orientation did not differ between groups. No hip had a PJI or osteolysis in either group. All acetabular components and all but two femoral components (in the Delta group) were well fixed. Dislocations occurred in six (1.9%) hips in the Forte group and one (0.3%) hip in the Delta group (p = 0.124). A total of nine (1.5%) revisions were performed. The 5-year survival rates for all-cause revisions were 98.4 and 98.6%, respectively. One (0.3%) ceramic head fracture occurred in the Forte group. Sixteen (5%) hips exhibited clicking and 6 (2%) hips had squeaking in the Forte group; 16 (6%) hips exhibited clicking and 5 (2%) hips had squeaking in the Delta group. Multiple regression analysis revealed that noise generation was unassociated with any factor.ConclusionsFrom the Korean Hip Registry data, THA with modern ceramic bearings showed encouraging results, with lower risks of PJI, osteolysis, and component loosening. In particular, Delta COC THA resulted in no PJI or ceramic fracture and had a reduced dislocation risk. However, associated noise remains a concern.
Highlights
Using data from the Korean Hip Registry, we aimed to investigate mid-term clinical and radiographic outcomes, including the prevalence of periprosthetic joint infection (PJI), osteolysis, and component loosening or dislocation, and to analyze the incidence of bearing-related complications following modern ceramic-on-ceramic (COC) total hip arthroplasty (THA) using a single cementless hip system
Ceramic bearing surfaces have been developed as an alternative to metal-on-polyethylene bearings in total hip arthroplasty (THA) in an attempt to reduce wear and improve implant longevity [1, 2]
The etiologies of ceramic fracture and noise generation are multifactorial, some previous studies have demonstrated that implant design, with regard to stem characteristics, geometry, and taper design or taper mismatch, can have an impact on these problems unique to hard-onhard bearings [7, 12]
Summary
Using data from the Korean Hip Registry, we aimed to investigate mid-term clinical and radiographic outcomes, including the prevalence of periprosthetic joint infection (PJI), osteolysis, and component loosening or dislocation, and to analyze the incidence of bearing-related complications following modern ceramic-on-ceramic (COC) total hip arthroplasty (THA) using a single cementless hip system. Despite the greater use of COC bearings over the last decade, major concerns persist regarding potential adverse events such as ceramic fracture [2, 6, 8, 10], noise generation [11,12,13,14,15], and a decreased positional range of error during liner insertion [10, 16] These concerns, as well as the increased cost of the implant, remain the principal barriers to the wide adoption of ceramics, even after the introduction of a modern alumina matrix composite (AMC) ceramic (BIOLOX® Delta; CeramTec AG, Plochingen, Germany) to address some of the concerns raised with the pure alumina (PA) ceramic design (BIOLOX® Forte). To our knowledge, few studies have investigated the clinical and radiographic outcomes of the use of modern PA and AMC COC bearings in cementless THA with a single implant system with mid- to longer-term follow-up
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