Good clinical outcomes following total hip arthroplasty using large-diameter ceramic-on-ceramic bearings

Large-diameter heads (LDHs) in total hip arthroplasty (THA) enhance range of motion but require thinner liners. Monoblock acetabular components with ceramic liners could reduce liner fracture risks during modular acetabular component assembly. This study aims to confirm the safety and clinical performance of the monoblock Maxera Cup in THA. The study included 198 consecutive patients who received 214 primary monoblock acetabular components with an LDH ceramic-on-ceramic (CoC) bearing between March 2012 and December 2013. We collected Harris hip scores (HHS), Oxford hip scores (OHS), EuroQoL-5D scores (EQ-5D), and conducted radiographic evaluations. Seven patients (3.5%) died for reasons unrelated to the intervention. A single patient (0.3%) underwent cup revision due to recurrent dislocation from trauma. Another patient needed cup revision six years post-surgery due to squeaking. Mean follow-up time was 36.2 ± 27.9 months. Kaplan-Meier survivorship rate at 96 months for any component loosening was 100%, and the cup revision survivorship rate for any reason was 96.8% (95% CI, 87.8-99.5%). At final follow-up, mean HHS was 93.6 ± 9.9, OHS was 16.2 ± 5.9, and EQ-5D was 0.94 ± 0.09. LDH CoC THA using a monoblock cup yielded excellent medium-term functional outcomes. This approach eliminates liner fracture risk during insertion and reduces implant impingement risk.