title: Ceramic-on-ceramic total hip arthroplasty: minimum of six-year follow-up study.
abstract: BACKGROUND
  This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years.
  
  
  METHODS
  We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures.
  
  
  RESULTS
  The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years.
  
  
  CONCLUSIONS
  The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.
authors.affiliation: Department of Orthopaedic Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Won-Sik
authors.initials: WS
authors.lastname: Choy
authors.forename: Kap Jung
authors.initials: KJ
authors.lastname: Kim
authors.forename: Sang Ki
authors.initials: SK
authors.lastname: Lee
authors.forename: Kyoung Wan
authors.initials: KW
authors.lastname: Bae
authors.forename: Yoon Sub
authors.initials: YS
authors.lastname: Hwang
authors.forename: Chang Kyu
authors.initials: CK
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002516:Ceramics; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular
keywords: Ceramic-on-ceramic; Hip; Total hip arthroplasty