Excellent Results of Large-Diameter Ceramic-On-Ceramic Bearings in Total Hip Arthroplasty at Minimum Ten-Year Follow-Up

This study reports the minimum 10 years results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head ceramic-on-ceramic bearing. Of the 276 THAs included in this study, there were eleven deaths and 27 patients lost to follow up (11%) during the follow-up, leaving 237 (85%) hips available for review at a mean of 10.5 years (range, 10 to 12) postoperatively. Reoperations, implant revisions, adverse events, clinical outcomes, radiographic evaluation, and whole blood metal ion levels were assessed at the last follow-up. After a minimum of 10 years, implant survivorship was 98.7%. There were 3 revisions (1.3%): one for insufficient acetabular cup primary fixation, one traumatic periprosthetic acetabular fracture, and one probable deep chronic infection. No dislocation or ceramic implant fracture was observed. The mean University of California at Los Angeles activity score, Western Ontario and McMaster Universities Osteoarthritis Index score, and Forgotten Joint Score were 5.6 (2 to 10), 90.1 (9 to 100), and 79.2 (4 to 100), respectively. All patients (100%) were satisfied or very satisfied. Since implantation, 43% of patients reported hearing a squeaking noise from the prosthesis. But all patients who reported squeaking were satisfied with the surgery. The mean titanium level was 2.2 μg/L (1.1 to 5.6). No progressive radiolucent lines, osteolysis, or implant loosening signs were observed at the last radiographic evaluation. A large-diameter head ceramic-on-ceramic THA provides outstanding long-term (minimum 10 years) implant survivorship with unrestricted activity while avoiding implant impingement, liner fracture, and hip instability. Functional outcomes, satisfaction, and joint perception were excellent. Although the incidence of squeaking was high, it did not affect patient satisfaction or function. The systemic titanium levels were low, related to unavoidable passive corrosion of implant surfaces, and did not reveal any indirect signs of trunnionosis.