Ceramic-on-ceramic vs metal-on-crosslink polyethylene in a fully hydroxyapatite-coated total hip arthroplasty: Survivorship, complications and long-term results.

BACKGROUND

Few studies compare complications and results in ceramic-ceramic (CeCe) vs metal-on-crosslink polyethylene (Me-XLPE) hip prosthesis.

METHODS

Prospective, non-randomized, observational analysis of 2 series of hydroxyapatite-coated Furlong Active implanted with identical protocol by 1 surgeon in 1 hospital from 2006 to 2014.

BEARING SURFACE: CeCe (Biolox Forte/Delta) in 35 cases of 53.7 ± 10.6 years (25-69) (21 males, 60 %), Me-XLPE in 65 of 69.0 ± 8.9 years (42-81) (36 males, 55 %); age was different (p < 0.00001), but not sex (p = 0.6565). Head diameter: 28 mm in 19, 32 mm in 9 and 36 mm in 7 CeCe hips; 28 mm in 63, 32 mm in 1 and 36 mm in 1 Me-XLPe hips.

FOLLOW-UP: 10.5 ± 3.1 years (1-15) in ceramic, 9.8 ± 3.8 years (2-15) in Me-XLPE.

RESULTS

Survivorship without additional surgery or closed reduction at 15 years: 91.0 % in ceramic, 83.8 % in Me-XLPE joints. Survivorship without component exchange at 15 years: 93.9 % in ceramic, 93.6 % in Me-XLPE joints.

COMPLICATIONS: CeCe joints suffered 2 infections, 1 isolated dislocation, and 1 Vancouver-C fracture. Me-XLPE joints presented 2 infections (p = 0.6101), 5 isolated (p = 0.6621) and 2 recurrent dislocations (p = 0.5454), and 4 Vancouver-B fractures (p = 0.6548).At final follow-up, Harris Hip Score averaged 93.2 ± 13.7 (23-100) in ceramic and 94.3 ± 8.7 (65-100) in XLPE joints (p = 0.64552).Measured radiographic wear reached 0.06 ± 0.38 mm (0-1.5) (0.0057 mm/year) in CeCe and 0.16 ± 0.5 mm (0-2) (0.0163 mm/year) in Me-XLPE (p = 0.30302). At final radiographic follow-up, osteolysis was present in 8 Charnley-De Lee zones (6 patients) (17 %) of ceramic cups and in 25 zones (15 patients) (23 %) of XLPE cups (p = 0.980127).

CONCLUSION

At 10 years follow-up, metal-XLPE and ceramic-ceramic joints in Furlong-H-A.C. Active present no significant differences in complications, clinical score, wear, acetabular osteolysis, or survivorship without component exchange.Nevertheless, survivorship without any surgery or closed reduction is different because of the high rate of dislocation in 28 mm metal-poly joints.