The Survival Analysis in Third-Generation Ceramic-On-Ceramic Total Hip Arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Medical Device Engineering

Background:

• Ceramic-on-ceramic (CoC) bearings are widely used in total hip arthroplasty (THA) due to their low wear rates.
• However, concerns regarding ceramic fracture and squeaking persist.
• Understanding long-term outcomes and failure modes is crucial for patient selection and implant design.

Purpose of the Study:

• To evaluate the long-term clinical outcomes and failure modes of third-generation ceramic-on-ceramic total hip arthroplasty.
• To identify specific implant characteristics associated with adverse events, particularly ceramic fracture.
• To assess the survivorship and revision rates of CoC articulations.

Main Methods:

• Retrospective review of 577 primary THA cases using third-generation CoC articulation.
• Average follow-up period of 5.9 years.
• Analysis of revision rates, fracture events (liner and head), squeaking, and survivorship based on femoral head size and neck length.

Main Results:

• A total of 527 patients (577 hips) were reviewed.
• Seven hips experienced liner fracture and 14 hips experienced head fracture, a higher rate than reported in other studies.
• Squeaking occurred in eight hips. The overall revision rate was 5.2%, with 1.6% revision for reasons other than ceramic fracture.
• Mean 10-year survivorship was 93%.
• A 28 mm femoral head with a short neck demonstrated the worst 10-year survivorship (89%).

Conclusions:

• Third-generation ceramic-on-ceramic THA demonstrated a higher incidence of ceramic fracture compared to previous literature.
• While overall survivorship remains high, specific femoral head and neck combinations may be associated with increased risk.
• Further investigation into the causes of ceramic fracture and optimization of implant design is warranted.