Does acetabular inclination angle affect survivorship of alumina-ceramic articulations?
BACKGROUND
Reports in the literature have linked high acetabular inclination angles to increased wear of ceramic-on-ceramic bearings. However, many of these studies were only conducted in vitro and did not address the clinical relevance of such findings.


OBJECTIVE
We therefore determined: (1) whether the cup inclination angle influences survival or function in patients with ceramic-on-ceramic implants; (2) the incidence of radiolucencies, osteolysis, and subsidence of ceramic-on-ceramic implants; and (3) whether the survival rate higher for ceramic-on-ceramic THAs than for conventional metal-on-polyethylene THAs.


METHODS
We retrospectively reviewed 537 THAs performed in 512 prospectively followed patients having THA between October 1996 and October 2000. Eleven patients (12 hips) were lost to followup before 2 years, leaving 501 patients (525 THAs); of these, 421 were alumina ceramic-on-ceramic articulations and 104 cobalt-chromium-on-polyethylene. The mean age was 54 years. We determined acetabular cup inclination angles, Harris hip scores, Health-Status-Questionnaire-12 scores, and presence and location of any radiolucencies, osteolysis, or radiographic subsidence. We compared survival using the Kaplan-Meier method. The minimum followup was 24 months (mean, 59 months; range, 24-120 months).


RESULTS
Twenty-two of the 424 THAs (4.2%) were revised. We observed no difference in clinical or radiographic outcomes with respect to cup inclination angles. Radiographically, two loose acetabular components and two femoral components had subsided. The 5-year survival rate was slightly higher for ceramic-on-ceramic bearings (98%) than for metal-on-polyethylene (92%).


CONCLUSIONS
Although there may be a link between acetabular inclination angles and wear rates as reported by some authors, we found no differences in patient function or radiographic survivorship using alumina-on-alumina articulations.
Department of Orthopedic Surgery, University Hospital Rostock, Rostock, Germany.
Henning R
HR
Johansson
Aaron J
AJ
Johnson
Michael G
MG
Zywiel
Marybeth
M
Naughton
Michael A
MA
Mont
Peter M
PM
Bonutti
D000077:Acetabulum / Q000601:surgery*; D000537:Aluminum Oxide; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008422:Materials Testing / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D013997:Time Factors
D000537:Aluminum Oxide