Related Experiment Video
Updated: Jun 10, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Quarter Century Outcomes of Alumina Ceramic-on-Ceramic Total Hip Arthroplasty
Hong Seok Kim1, Jeong Joon Yoo1
1Department of Orthopedic Surgery, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea.
Background:
Alumina ceramic-on-ceramic (CoC) bearings were widely used in total hip arthroplasty (THA) due to their superior wear resistance and inert properties, making them ideal for young, active patients who require long-lasting implants. This study aimed to synthesize findings from previous reports, providing a comprehensive follow-up of at least 25 years on the clinical and radiologic outcomes, the prevalence of osteolysis, and implant survivorship in patients undergoing primary cementless CoC THA.
Methods:
We have previously reported 5- to 10-year outcomes following the implementation of third-generation alumina-on-alumina bearings in a consecutive series of 100 primary cementless THAs. This report updates those results with a minimum follow-up of 25 years. Of the original cohort, 58 patients who had 67 hips were available for the latest follow-up. Clinical assessments were performed using the Harris Hip Score and pain questionnaires. Radiographic evaluations were employed to assess implant fixation and osteolysis.
Results:
At the final follow-up, the implant survival rate was an impressive 96.3%, with revision of the implant as the end point. The mean Harris Hip Score improved significantly from preoperative values to 90.1, indicating excellent functional outcomes. The incidence of ceramic-related noise increased over time, with three cases of ceramic head fractures requiring a change of bearings. Notably, the extent of stem notching observed in earlier reports did not show further progression. Radiologically, all implants demonstrated bony ingrowth with no signs of aseptic loosening or major osteolysis.
Conclusions:
The long-term (minimum 25-year) follow-up of alumina-on-alumina bearings in primary cementless THA demonstrates outstanding implant survivorship, excellent functional outcomes, and minimal adverse effects over 25 years. Despite some issues like ceramic-related noise and component fractures, the overall performance of CoC bearings remains highly encouraging, particularly suitable for young, active patients. Surgeons should provide appropriate education to both potential THA candidates and patients who already have THAs with CoC bearings.
Level Of Evidence:
Therapeutic Level IV.
