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Updated: Jun 8, 2025
Potentiodynamic Corrosion Testing
Published on: September 4, 2016
Long-term follow-up of ceramic-on-metal total hip arthroplasty
Gavin Baker1, Janet Hill1, Francis O'Neill1
1Primary Joint Unit, Musgrave Park Hospital, Belfast, UK.
Insights
Longer-term follow-up of ceramic-on-metal total hip arthroplasties shows increased revision rates and deterioration in pain scores and implant survival. These findings highlight concerns for metal-on-metal bearing implants and similar designs.
Area of Science:
- Orthopaedic surgery
- Biomaterials science
- Clinical outcomes research
Background:
- Initial 2015 study reported 3.1% revision rate for ceramic-on-metal total hip arthroplasties (CoM THAs) with 34-month follow-up.
- This paper presents longer-term outcomes to assess implant survival and patient well-being over time.
Purpose of the Study:
- To evaluate the long-term revision rate, pain, functional outcomes, and radiological findings of CoM THAs.
- To compare outcomes at approximately 6 and 10 years post-implantation.
Main Methods:
- 264 patients with CoM THAs were reviewed at mean follow-ups of 5.8 and 10.1 years.
- Data collected included revision rates, pain scores (VAS), Oxford Hip Score (OHS), blood ion levels, and radiographic analysis.
- Telephone contact was used for patients unable or unwilling to attend follow-up appointments.
Main Results:
- All-cause revision rate increased from 3.1% at 6 years to 8.8% at 10 years.
- Significant deterioration in pain scores and OHS was observed between 6 and 10 years.
- Radiolucent lines increased significantly, and implant survival at 10 years (91.2%) did not meet ODEP 10 A* 95% threshold.
Conclusions:
- CoM THAs demonstrated significant long-term deterioration in clinical and radiographic outcomes.
- The observed implant survival rate is suboptimal, raising concerns about the longevity of this bearing type.
- Findings are relevant to understanding risks associated with modular dual-mobility implants with similar metal interfaces.
Aims:
In 2015, we published the results of our ceramic-on-metal (CoM) total hip arthroplasties (THAs) performed between October 2007 and July 2009 with a mean follow-up of 34 months (23 to 45) and a revision rate of 3.1%. The aim of this paper is to present the longer-term outcomes.
Methods:
A total of 264 patients were reviewed at a mean of 5.8 years (4.6 to 7.2) and 10.1 years (9.2 to 10.6) to determine revision rate, pain, outcome scores, radiological analysis, and blood ion levels. Those who were unwilling or unable to travel were contacted by telephone.
Results:
The all-cause revision rate at six years was 3.1% (eight THAs), increasing to 8.8% (18 THAs) at ten years. Of these, there were four and then seven bearing-related revisions at six and ten years, respectively. There was a statistically significant deterioration in the visual analogue scale pain score and Oxford Hip Score (OHS) between six and ten years. There were 18 CoM THAs in 17 patients who had a cobalt or chromium level over 4 ppb and ten CoM THAs in nine patients who had a cobalt or chromium level higher than 7 ppb with a statistically significant increase in chromium levels only between the two timepoints. Overall, 84 stems (39.1%) had significant radiolucent lines at ten years compared to 65 (25.5%) at six years.
Conclusion:
When compared to the original review, there has been a significant deterioration in pain score, OHS, radiograph appearance, and, most critically, survival has fallen to 91.2%, which does not meet the Orthopaedic Data Evaluation Panel (ODEP) 10 A* 95% threshold. Although this bearing is no longer on the market, 2.5% were bearing-related revisions, which have relevance to the discussion around modular dual-mobility implants that have a similar metal interface.
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