Primary Ceramic-on-ceramic Total Hip Arthroplasty Using a 32-mm Ceramic Head With a XXXX -alloy Sleeve.

@entity691 @entity1 @entity174 @entity3061 @entity572 @entity702 @entity5383
BACKGROUND: Modern ceramic-on-ceramic bearings have become attractive alternatives to conventional @entity691 in total hip arthroplasty (THA) as a result of their low wear and minimal particle production. However, 28-mm heads in ceramic-on-ceramic bearing couples have been associated with ceramic @entity174 . To address these issues, 32-mm and larger ceramic heads with a @entity702 -alloy sleeve have been introduced, although limited data are available on their durability and clinical outcomes. QUESTIONS/PURPOSES: We determined (1) the survivorship of the primary ceramic-on-ceramic THA using a 32-mm ceramic head with a @entity702 -alloy sleeve at a minimum followup of 5 years; (2) Harris hip scores; (3) the incidence of ceramic @entity174 and noisy hip; and (4) the proportion of @entity572 showing radiographic evidence of @entity3061 . METHODS: From November 2005 to August 2009, we performed 301 ceramic-on-ceramic THAs using a 32-mm ceramic head with a @entity702 -alloy sleeve in 270 @entity1 . Of these, 12 @entity1 (12 @entity572 [4%]) died from problems unrelated to surgery and 13 @entity1 (15 @entity572 [5%]) were lost during followup before a minimum of 5 years had been reached, leaving 245 @entity1 who had 274 THAs with a minimum followup of 5 years (mean, 6.5 years; range, 5-9 years) in this retrospective analysis. During the study period, 30% (301 of 997 @entity572 ) were performed with this articulation based on the operating surgeon's discretion. The mean @entity1 age at the time of surgery was 55 years (range, 16-82 years). All operations were performed at a single center. All of the ceramic implants were hot isostatic-pressed, laser-marked, proof-tested third-generation @entity5383 . We determined the implant survival, Harris hip scores, incidence of ceramic @entity174 or noisy @entity572 (based on a questionnaire), and presence of @entity3061 . RESULTS: The survival rate of ceramic-on-ceramic bearings in primary THA using a 32-mm ceramic head with a @entity702 -alloy sleeve was 98% (95% confidence interval, 96%-100%) at 9 years. The Harris hip score improved from a mean of 47 points preoperatively to 93 points at last followup. One ceramic head fractured at 6 years postoperatively. No ceramic liners fractured. Audible hip clicking and squeaking were identified in four @entity572 and one hip, respectively. @entity3061 was detected in three @entity572 , but none had symptoms. CONCLUSIONS: Primary ceramic-on-ceramic THA using a 32-mm ceramic head with a @entity702 -alloy sleeve has a survivorship of 98% at 9-year followup. Nevertheless, surgeons should be aware of the potential risks of ceramic @entity174 , noise, and @entity3061 associated with the use of a ceramic head with a @entity702 -alloy sleeve. LEVEL OF EVIDENCE: Level IV, therapeutic study.
