JOA - 2026-06-12 - Journal Article
Complications of Ceramic-on-Ceramic Total Hip Arthroplasty with Large Heads: 10-Year Minimum Follow-Up.
Lee DH, Park JW, Jung WH, Kim TY, Ha YC, Koo KH, Lee YK
Topics
Key Takeaway
Large-head (32/36 mm) ceramic-on-ceramic THA achieved 99.1% revision-free survival at 12 years with zero ceramic fractures and only 0.5% focal osteolysis, but a 5.5% articular noise rate and late instability from lumbar degenerative kyphosis remain concerns.
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Summary
This prospective multicenter study evaluated cementless THA using 32/36 mm fourth-generation ceramic-on-ceramic bearings in 201 hips followed a mean of 12.3 years, assessing ceramic fracture, noise, osteolysis, and survival. Zero ceramic fractures occurred; articular noise was present in 11 hips (5.5%), new focal osteolysis in 1 hip (0.5%), and mean HHS was 87.0 ± 11.5. Kaplan-Meier revision-free survival was 99.1% (95% CI 97.9–100.0) at 12 years, with one late dislocation attributable to lumbar degenerative kyphosis-induced posterior impingement.
Key Limitation
Loss of 27% of the original cohort to follow-up (274 enrolled, 201 analyzed) risks survivorship bias, as patients with complications may be disproportionately lost.
Original Abstract
BACKGROUND
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 (CoC) total hip arthroplasty (THA).
METHODS
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 (CT) scans in 47 hips (23%, 47 of 201). Kaplan-Meier survival analysis was performed with revision and reoperation as endpoints.
RESULTS
In addition to previously reported three dislocations, the new one sustained anterior instability due to lumbar degenerative kyphosis (LDK) 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 (CI), 97.9 to 100.0), and any operation was 98.7% (95% CI, 97.2 to 100.0) at 12 years postoperatively.
CONCLUSION
Our findings revealed that a large head CoC bearing could prevent early dislocation without any risk of liner fracture even in a thinner ceramic liner. However, there might still be concern of LDK-associated late instability and noise even with a large head in long-term follow-up.