Ceramic-on-ceramic bearings: Assured longevity in patients younger than 60 years?

摘要

Ceramic-on-ceramic bearings are used in around a fifth of all total hip arthoplasties carried out in Australia. The Australian Orthopaedic Assocation National Joint Replacement Registry data from 2016 shows that ceramic has better 15-year survivorship than any other bearing surface, even in patients under the age 55 years. Wear rates can be measured on retrieval analysis and patterns of wear identified. Ceramic also demonstrates good biocompatibility with very little inflammatory response to debris produced in comparison with polyethylene and metal-on-metal bearing surfaces. Squeaking is an infrequent complication and rarely a cause of revision. Ceramic-on-ceramic bearings were first developed in Europe in the 1970s. The initial design resulted in high levels of failure, largely due to loosening of the acetabular component. Because of this, it was several years before the modern materials and component designs became more commonly utilized throughout the rest of the world. In 2016, 363, 561 primary total hip arthroplasties were carried out in Australia, with 20% of these having a ceramic-on-ceramic bearing surface [1]. In patients under the age of 55 years, revision rates of ceramic-on-ceramic bearings at 10 and 15 years are 5.2% and 6.6%, respectively. A 10-year survival of small head (<32 mm) metal-on-metal bearings, and metal or ceramic on cross-linked polyethylene are similar to that of ceramic-on-ceramic bearings. The only other bearing surface with 15-year survival data available in the Australian Joint Registry is non-cross-linked polyethylene, which performs poorly with a revision rate of 17%. It remains to be seen whether cross-linked polyethylene will continue to perform well at 15 years and beyond.