title: Uncemented third-generation ceramic-on-ceramic total hip arthroplasty using metal acetabular shell with direct taper locking liner.
abstract: BACKGROUND
  The ceramic-on-ceramic (CoC)-bearing couple in total hip arthroplasty (THA) was developed to reduce the wear debris and osteolysis. Although the mechanical strength of third-generation ceramic has improved over previous generations, the risk of osteolysis and ceramic fracture is still an important concern.
  
  
  METHODS
  We studied 124 uncemented THAs with third-generation CoC-bearing couple implanted between 2000 and 2004. The ceramic liner and head were secured with the direct taper locking mechanism. One hundred and eleven hips were followed-up for minimum of 8 years, with an average follow-up period of 10.1 years (range 8.0-12.8 years). Patients were evaluated with a particular emphasis on the prevalence of the osteolysis and the ceramic fracture.
  
  
  RESULTS
  The survivorship with the end point as implant revision for any reason was 94.9 % (95 % confidence intervals 90.0-99.3 %) at 12.8 years. Revisions were performed because of one ceramic liner fracture, three dislocations, and two deep infections. No radiographic evidence of wear or osteolysis was observed. The preoperative Merle d'Aubigne and Postel hip score increased from 11.6 to 17.1.
  
  
  CONCLUSIONS
  Patients, who received third-generation CoC THA had no detectable wear and osteolysis. One ceramic fracture occurred, and the main reason for revision was dislocation.
authors.affiliation: Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chuo-ku, Niigata, Niigata, 950-1151, Japan. s8058@nms.ac.jp
authors.forename: Sachiyuki
authors.initials: S
authors.lastname: Tsukada
authors.forename: Motohiro
authors.initials: M
authors.lastname: Wakui
authors.forename: Munenori
authors.initials: M
authors.lastname: Matsueda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D002484:Cementation; D002516:Ceramics; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation