title: High survivorship with a titanium-encased alumina ceramic bearing for total hip arthroplasty.
abstract: BACKGROUND
  Although ceramic-on-ceramic bearings for total hip arthroplasty (THA) show promising results in terms of bearing-surface wear, fracture of the bearing, insertional chips, and squeaking remain a concern.
  
  
  OBJECTIVE
  Our primary objective of this report was to determine overall survivorship of a titanium-encased ceramic-on-ceramic bearing couple. Our secondary objectives were to evaluate for ceramic fracture, insertional chips, osteolysis, and device squeaking.
  
  
  METHODS
  Six surgeons at six institutions implanted 194 patients (209 hips) with an average age of 52 years with cementless hips and alumina ceramic bearings. One hundred thirty-seven patients (146 hips) have 10-year followup (70%). We determined Kaplan-Meier survivorship of the bearing surface and implant system and collected radiographic and clinical data to evaluate for osteolysis and squeaking.
  
  
  RESULTS
  Survivorship using revision for any reason as the end point was 97% at 10 years and survivorship end point bearing surface failure or aseptic loosening of 99%. There was one ceramic insert fracture (0.5%), there were no insertional chips, there was no visible osteolysis on AP and lateral radiographs, and there was a 1% patient-self-reported incidence of squeaking at the last clinical followup. Six hips underwent revision (3.7%).
  
  
  CONCLUSIONS
  Ceramic bearings for THA with a titanium-encased insert have high survivorship at 10 years followup and a fracture risk of 0.5%. We found at last followup on routine radiographs no evidence of osteolysis, and no patient has been revised for squeaking or has reported dissatisfaction with the clinical result because of noise. IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Greater Pittsburgh Orthopaedics Association, 725 Cherrington Parkway, Suite 200, Moon Township, PA, 15108, USA, dantonioja@me.com.
authors.forename: James A
authors.initials: JA
authors.lastname: D'Antonio
authors.forename: William N
authors.initials: WN
authors.lastname: Capello
authors.forename: Marybeth
authors.initials: M
authors.lastname: Naughton
mesh_terms: D000328:Adult; D000537:Aluminum Oxide; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009622:Noise; D010014:Osteolysis / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013314:Stress, Mechanical; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome; D014481:United States
chemical_list: D014025:Titanium; D000537:Aluminum Oxide
references.citation: J Bone Joint Surg Am. 2010 Mar;92(3):550-7
references.pmid: 20194312
references.citation: Clin Orthop Relat Res. 2012 Feb;470(2):373-81
references.pmid: 21918802
references.citation: J Orthop Traumatol. 2012 Mar;13(1):21-7
references.pmid: 22249776
references.citation: J Arthroplasty. 2009 Aug;24(5):743-50
references.pmid: 18555652
references.citation: J Bone Joint Surg Br. 1994 Jan;76(1):53-9
references.pmid: 8300682
references.citation: J Bone Joint Surg Am. 2009 Jun;91(6):1344-9
references.pmid: 19487511
references.citation: Biomaterials. 2003 Feb;24(3):469-79
references.pmid: 12423602
references.citation: Clin Orthop Relat Res. 2000 Oct;(379):48-54
references.pmid: 11039792
references.citation: J Arthroplasty. 2012 May;27(5):736-41
references.pmid: 21978563
references.citation: J Bone Joint Surg Am. 2010 Jul 21;92(8):1715-9
references.pmid: 20660234
references.citation: J Bone Joint Surg Am. 2007 Dec;89(12):2676-83
references.pmid: 18056500
references.citation: J Bone Joint Surg Am. 2005 Mar;87(3):592-7
references.pmid: 15741627
references.citation: J Arthroplasty. 2012 Mar;27(3):445-53
references.pmid: 21676580
references.citation: Clin Orthop Relat Res. 2005 Dec;441:151-8
references.pmid: 16330998
references.citation: Clin Orthop Relat Res. 2010 Sep;468(9):2340-5
references.pmid: 20099084
references.citation: Int Orthop. 2010 Dec;34(8):1123-7
references.pmid: 19784647
references.citation: Clin Orthop Relat Res. 2003 Dec;(417):19-26
references.pmid: 14646699
references.citation: J Bone Joint Surg Am. 2012 Jan 18;94(2):138-44
references.pmid: 22258000
references.citation: Clin Orthop Relat Res. 1992 Sep;(282):19-30
references.pmid: 1516312
references.citation: Clin Orthop Relat Res. 2012 Dec;470(12):3530-6
references.pmid: 22826015