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A prospective randomised controlled trial comparing three alternative bearing surfaces in primary total hip
V S Nikolaou1, M R Edwards, E Bogoch
1St Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1WB, Canada. vassilios.nikolaou@gmail.com
The Journal of Bone and Joint Surgery. British Volume
|March 22, 2012
Summary
For young patients undergoing total hip replacement (THR), ceramic-on-ceramic bearings showed no significant wear over five years. Cobalt-chrome on highly cross-linked polyethylene demonstrated reduced wear compared to standard polyethylene.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Clinical Trials
Background:
- The optimal bearing surface for total hip replacement (THR) in younger patients (<65 years) is debated.
- Previous studies have shown varying outcomes with different bearing materials.
Purpose of the Study:
- To compare the five-year clinical and radiological outcomes of three bearing surfaces in THR for young patients.
- To evaluate wear rates and patient-reported outcomes for different THR bearing materials.
Main Methods:
- A randomized controlled trial involving 102 THRs in 91 patients (<65 years).
- Patients were randomized to cobalt-chrome on ultra-high-molecular-weight polyethylene, cobalt-chrome on highly cross-linked polyethylene, or ceramic-on-ceramic bearings.
- Clinical outcomes assessed using WOMBAT, SF-12, and Harris hip scores; radiological outcomes included wear analysis.
Main Results:
- No significant clinical differences were observed between the groups at five years.
- Ceramic-on-ceramic bearings showed no measurable wear.
- Highly cross-linked polyethylene exhibited a threefold lower wear rate (0.059 mm/year) compared to standard polyethylene (0.151 mm/year).
Conclusions:
- Ceramic-on-ceramic and highly cross-linked polyethylene appear to be favorable bearing options for THR in younger patients.
- Highly cross-linked polyethylene demonstrates significantly reduced wear compared to conventional ultra-high-molecular-weight polyethylene.
