Is alumina-on-alumina ceramic bearings total hip replacement the right choice in patients younger than 50 years of age? A 7- to 15-year follow-up study

Introduction: The alumina-on-alumina bearing couple in total hip replacement seems to be well adapted for young and active patients because of the absence of wear and the rarity of osteolysis. Over the long term, doubts persist as to the cementless cup fixation and on the functioning of this bearing system because of possible acoustic emissions during use.

Hypothesis: In young subjects, the ceramic-on-ceramic bearing system limits wear and osteolysis occurrences, without exposing patients to serious side effects. MATERIAL AND MEHTODS: We report the results, with between 7 and 15 years of follow-up, for 32mm-diameter alumina-on-alumina implants in 76 patients younger than 50 years of age (83 hips), combining cementless press-fit hemispheric cups with titanium stems, [either cemented (63 Osteal™ stems) or cementless (20 Multicône™ stems)], with particular attention paid to cup fixation and noise emissions during implant function. First-generation or Cerafit trellis™ acetabular components had a riveted titanium mesh (31 cases), whereas the most recent (Cerafit hydroxyapatite [HA]™) cups had a porous surface coated with hydroxyapatite (52 cases).

Results: Three cases of aseptic loosening of the cemented stems were observed as well as late migration of a Cerafit trellis™ cup in the 12th postoperative year. One ceramic insert broke in the eighth postoperative year. With the exception of one case, the patients, questioned retrospectively, reported no audible noise. With aseptic loosening (revised or not), the criterion for failure, the 12-year survival rate was 91±11% for the Cerafit trellis™ acetabular components and 91±16% for the cemented Osteal™ stems. The 9- and 7-year survival rates for the Cerafit HA™ cups and the Multicône™ stems, respectively, were 100%. Including all revisions for any cause, the 10-year survival rate of the entire series was 92%±11%.

Discussion: Despite the absence of wear and osteolysis, the long-term survival of these implants in young subjects should be improved. Although longer follow-up is necessary to formulate a definitive opinion, we tend to prefer cementless stem and cup fixation in ceramic-on-ceramic bearing systems.

Level of evidence: Level 4 retrospective study.