Fourth-Generation Ceramic-On-Ceramic THA With Anatomic and Tapered Femoral Stems: 11-Year Follow-Up

Total hip arthroplasty (THA) with Ceramic-on-Ceramic (CoC) components achieved excellent outcomes. However, the long-term outcomes of anatomic and tapered stems are controversial in clinical practice, and the difference in the survival rates between the tapered stems and anatomical stems over the long term remains unknown.

A retrospective cohort study was performed to evaluate the 11-year follow-up outcomes of anatomic and tapered femoral stems. Between January 2009 and December 2011, a total of 1438 patients with COC were included in this study initially. Among these hips, 30 patients (30 hips) experienced death, and 254 hips (17.6%) were lost to follow-up. Finally, a total of 591 hips with Corail stem and a total of 334 hips with Ribbed stems were included in this study. The outcomes were evaluated by the modified Harris hip score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a questionnaire assessing articular noises.

For the Corail stem, the survival rate with aseptic loosening or revision of any component for any reason as the endpoint was 99.1% at 11 years. The survival rate with reoperation for any reason as the endpoint was 98.8% at 11 years. For the Ribbed stem, the survival rate with aseptic loosening or revision of any component for any reason as the endpoint was 98.8% at 11 years. In patients with the Corail stem, the preoperative modified Harris hip score (mHHS) score, with a mean of 43.8 points, significantly improved to a mean of 93.5 points at the final follow-up assessment (p < 0.001). In patients with the ribbed stem, the preoperative mHHS score, with a mean of 40.9 points, significantly improved to a mean of 92.8 points at the final follow-up assessment (p < 0.001) during the follow-up period. The incidence of squeaking and squaking in the Corail group was significantly higher than that in the ribbed group (squeaking: 22.7% vs. 6.9%; squaking: 17.4% vs. 4.2%). The incidence of postoperative thigh pain was 4% in patients with the Corail stem, significantly lower than that in patients with the ribbed stem (17.4% vs. 4%; p < 0.001).

In conclusion, CoC THA with Corail and Ribbed stems exhibits excellent clinical outcomes at the long-term follow-up. However, the incidence of postoperative thigh pain in the Ribbed group is significantly higher than that in the Corail group, while the incidence of squeaking was lower.