Ten-Year Follow-Up of Patients Younger Than 50 Years With Modern Ceramic-on-Ceramic Total Hip Arthroplasty

Recent technologic advances in total hip arthroplasty (THA) have focused on improving the longevity and wear characteristics of bearing surfaces that can withstand the high demands of younger and more active patients. Recent reports of early failures of metal-on-metal THA have introduced doubts to its ability to be a viable long-term hard-on-hard bearing surface for hip arthroplasty. Like metal-on-metal, ceramic-on-ceramic (COC) bearing surfaces have excellent in vitro wear characteristics, but there is little information about their long-term track record in vivo, particularly in those patients who are younger and more active. The purpose of this study is to evaluate the long-term outcomes of COC THA in active patients younger than 50 years of age. We retrospectively reviewed 82 consecutive THAs in 64 patients performed by a single surgeon from 1997 to 2000. There were 42 men and 22 women with an average age of 38.6 years. Of the 82 THAs, 39 were performed for avascular necrosis of the hip, 30 for osteoarthritis, 8 for developmental dysplasia, and 5 for inflammatory or posttraumatic arthritis. Clinical outcomes were evaluated using the Harris hip score, and serial radiographs were evaluated for signs of component loosening. The mean follow-up period was 10.1 (range, 10.0-12.3) years. One patient died, and another was lost to follow-up. The mean Harris hip score was 89.8. There were no implants with subsidence or circumferential radiolucent lines. Two patients required revision surgery of their THA for a ceramic liner fracture. One patient complained of squeaking that required revision. There were no cases of revision for ceramic head fracture, instability, or aseptic loosening. At a minimum 10-year follow-up, the survivorship of the COC THA was 96.3%. Modern COC THA in active patients younger than 50 years of age is durable at a minimum 10-year follow-up; however, patients should be advised of the small chance of squeaking and ceramic fracture.