Complications of Ceramic-on-Ceramic Total Hip Arthroplasty With Large Heads: 10-Year Minimum Follow-Up

The fourth-generation ceramic bearings allow the use of larger femoral heads, but inevitably create thinner liners, raising concerns regarding liner fracture and long-term biological responses. We extended our study to evaluate late dislocation, ceramic-related complications, and long-term clinical and radiographic outcomes more than 10 years after ceramic-on-ceramic total hip arthroplasty (THA).

We conducted a prospective multicenter study of cementless THA using a 32/36-mm ceramic bearing. From April 2010 to February 2012, 246 patients (274 THAs) were enrolled. We evaluated ceramic fracture, noise, clinical results, radiological changes, and survival rate at a minimum of 10-year follow-up. In this study, 178 patients (100 men and 78 women, 201 hips) who had a mean age of 51 years (range, 18.9 to 77.6) at surgery were followed for a mean of 12.3 years (range, 10 to 14.6) with computed tomography scans in 47 hips (23%, 47 of 201). Kaplan-Meier survival analysis was performed with revision and reoperation as endpoints.

In addition to previously reported three dislocations, the new one sustained anterior instability due to lumbar degenerative kyphosis associated with posterior impingement. Ceramic fracture did not occur in any patient. The mean Harris Hip Score was 87.0 ± 11.5 points at the latest follow-up. New focal osteolysis was detected in one hip (0.5%). Articular noise was reported in 11 hips (5.5%). The survival rate for revision surgery was 99.1% (95% confidence interval, 97.9 to 100.0), and any operation was 98.7% (95% confidence interval, 97.2 to 100.0) at 12 years postoperatively.

Our findings revealed that a large head ceramic-on-ceramic bearing could prevent early dislocation without any risk of liner fracture even in a thinner ceramic liner. However, there might still be concern of lumbar degenerative kyphosis-associated late instability and noise even with a large head in long-term follow-up.