Long-term results of third-generation ceramic-on-ceramic bearing cementless total hip arthroplasty in young patients
- Young-Hoo Kim, MD, Jang-Won Park, MD, Jun-Shik Kim, MD
- The Journal of Arthroplasty (2016), doi: 10.1016/j.arth.2016.03.058. accepted manuscript.
- Level of Evidence:
- Level IV. Retrospective observational study. (Patients treated one way with no comparison group of patients treated in another way.)
Kim et al reviewed 871 patients 65 years of age or younger who had a cementless THA (DePuy: IPS stem, Duraloc shell) with a 28mm CoC bearing (B. Forte) implanted between 1995 and 2000. Primary diagnosis was mostly osteonecrosis of the femoral head (53%), followed by primary osteoarthritis, or secondary osteoarthritis due to dysplasia or childhood pyogenic arthritis (40%). Mean follow up was 18.8 years (range 15-20 years).
Harris Hip Score increased from 40 points before surgery to 95±2.9 points at 1 year, 93±5.9 at 5 years, 92±6.8 at 10 years, and 91±11.1 at 15 years and 90±9.9 at 20 years. No patient reported thigh pain at final follow-up. Fifty-seven hips (5%) had clicking sounds and 4 hips (0.4%) showed squeaking sounds. The 4 squeaking patients were not satisfied with their outcome, even though there were no other symptoms than the sound. There was no aseptic loosening of any component and no osteolysis. Dislocations occurred in 10 hips (0.9%), 7 of which were treated by closed reduction. Three patients had recurrent dislocations and the acetabular component was revised. Infections developed in 2 hips (0.2%), the femoral heads and inserts were exchanged, and intravenous antibiotics were given for 6 weeks. There was no recurrence of infection. Kaplan-Meier survivorship at 20 years for the femoral component was 100% with revision as endpoint and 99.7% for the acetabular component with revision as the endpoint.
The authors conclude that their cementless THA utilizing CoC bearings in patients younger than 65 years provides outstanding long-term fixation and provides a high rate of survivorship without evidence of osteolysis. Kim et al emphasized the importance of carefully following their patients, and concluded that ceramics were an excellent bearing option to address the limitations of other bearing surfaces.
Key Research Findings
- Cementless THA with CoC bearings show excellent long-term survivorship at 20 years
- No osteolysis and no ceramic fracture
- 0.4% squeaking hips, none revised
- CoC bearings can be used successfully without fractures if placed correctly and handled appropriately
- Single surgeon, single center
- Retrospective, observational case series, no control arm
- No information of causative microorganism