title: 3rd generation alumina-on-alumina in modular hip prosthesis: 13 to 18 years follow-up results.
abstract: BACKGROUND
  Ceramic-on-ceramic (CoC) couplings are alternative bearings surfaces that have been reported to reduce osteolysis, wear debris and aseptic loosening compared to the use of polyethylene. Early experiences with ceramics had poor results, but they have led to many improvements in the manufacture and design of subsequent implants.
  
  
  METHODS
  We analysed medical files of 300 CoC total hip arthroplasty (THA) with a modular neck performed during period 1995-2000 by a single surgeon for a minimum follow-up of 13 years, evaluating clinical and radiological outcome.
  
  
  RESULTS
  The mean clinical Merle d'Aubigne and Postel hip score at the final follow-up is 17.4, against a preoperative value of 11.4. Overall survivorship with an endpoint of revision is 93.2% (95% CI, 89.0%-97.3%) at 15 years, while considering only prosthesis failures related to aseptic loosening and ceramic breakage, survival rate at 15 years is 97.2% (95% CI, 94.8%-100%). We observed complications that led to revision surgery in 11 patients (4%) (periprosthetic fractures, liner ruptures, septic loosening of the implant, aseptic loosening of the cup, aseptic loosening of the stem). The occurrence of squeaking is low (1.6%, 4 cases) and we analysed the characteristics of these patients.
  
  
  CONCLUSIONS
  Our study shows an excellent long term survivorship of third generation alumina CoC THA. We reiterate the importance to have a stable implant to maximise the advantage of ceramic and to avoid complications.
authors: Orthopaedic-Traumatology and Prosthetic surgery and revisions of hip and knee, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors: Aldo
authors: A
authors: Toni
authors: Orthopaedic-Traumatology and Prosthetic surgery and revisions of hip and knee, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors: Federico
authors: F
authors: Giardina
authors: Orthopaedic-Traumatology and Prosthetic surgery and revisions of hip and knee, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors: Giovanni
authors: G
authors: Guerra
authors: Orthopaedic-Traumatology and Prosthetic surgery and revisions of hip and knee, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors: Alessandra
authors: A
authors: Sudanese
authors: Orthopaedic-Traumatology and Prosthetic surgery and revisions of hip and knee, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors: Maurizio
authors: M
authors: Montalti
authors: Medical Technology Laboratory, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors: Susanna
authors: S
authors: Stea
authors: Medical Technology Laboratory, Rizzoli Orthopaedic Institute, Bologna - Italy.
authors: Barbara
authors: B
authors: Bordini
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000537:Aluminum Oxide / Q000737:chemistry*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000537:Aluminum Oxide