title: Ceramic-Ceramic Hip Arthroplasty for Osteonecrosis: Average 5-year Follow-up in Patients Less Than 50 Years of Age.
abstract: BACKGROUND
  The optimal bearing surface for the young, active patient undergoing total hip arthroplasty (THA) is unknown. We sought to examine the clinical results of ceramic-on-ceramic (CoC) THA in patients under 50 years of age with a diagnosis of osteonecrosis.
  
  
  METHODS
  Fifty-three hips underwent cementless THA with a CoC articulation. Clinical and functional outcomes, including preoperative and postoperative WOMAC and UCLA scores, were recorded. Serial radiographs were studied for component loosening or evidence of osteolysis. Revision surgery for any reason was the primary clinical endpoint.
  
  
  RESULTS
  The average age at time of THA was 31.03 years (range: 15 to 50 years). Average follow-up was 64 months (range: 24 to 112 months). Average preoperative BMI was 25.3 (range: 20.1 to 39.4). WOMAC scores increased from a preoperative average of 37.1 (range: 3.9 to 70.2) to 89 (range: 11.7 to 100) at latest follow-up (p less than 0.05). UCLA scores improved from a preoperative average of 2.39 (range: 1 to 4) to 6.72 (range: 1 to 10) postoperatively (p less than 0.05). Forty-five percent of patients were highly active with UCLA scores between 8 and 10. There were no dislocations, deep infections, or ceramic component failures. One patient was revised for chronic pain at another institution, and one patient underwent revision for femoral component loosening. Three patients experienced squeaking, which did not affect quality of life.
  
  
  CONCLUSIONS
  At mid-term follow-up, THA with CoC bearings affords high activity level with excellent clinical outcomes and component longevity in young, active patients with osteonecrosis.
authors.forename: Perry J
authors.initials: PJ
authors.lastname: Evangelista
authors.forename: Atul F
authors.initials: AF
authors.lastname: Kamath
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Aversano
authors.forename: Jason
authors.initials: J
authors.lastname: Silvestre
authors.forename: Gwo-Chin
authors.initials: GC
authors.lastname: Lee
authors.forename: Charles L
authors.initials: CL
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D002516:Ceramics; D004185:Disability Evaluation; D005260:Female; D005271:Femur Head Necrosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011788:Quality of Life; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013499:Surface Properties; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult