Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2021; 12(1): 14-23
Published online Jan 18, 2021. doi: 10.5312/wjo.v12.i1.14
Ceramic-on-ceramic vs ceramic-on-polyethylene, a comparative study with 10-year follow-up
Justin van Loon, Daniël Hoornenborg, Harm M van der Vis, Inger N Sierevelt, Kim TM Opdam, Gino MMJ Kerkhoffs, Daniël Haverkamp
Justin van Loon, Daniël Hoornenborg, Harm M van der Vis, Inger N Sierevelt, Daniël Haverkamp, Department of Orthopedic Surgery, Xpert Orthopedie Amsterdam/SCORE (Specialized Center of Orthopedic Research and Education), Amsterdam 1101EA, The Netherlands
Justin van Loon, Kim TM Opdam, Gino MMJ Kerkhoffs, Department of Orthopedic Surgery, Amsterdam University Medical Centres, location Academic Medical Center, Amsterdam 1105AZ, The Netherlands
Inger N Sierevelt, Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp 2134TM, The Netherlands
Author contributions: All authors contributed to the study conception and design; Haverkamp D, Hoornenborg D, and van der Vis HM were involved in the follow-up after the surgical procedures; van Loon J and Sierevelt IN performed the data collection and analyses; van Loon J wrote the first draft of the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: This observational prospective single-center cohort study with a 10-year follow-up was part of the normal follow-up of a documented series of elective THAs. Therefore, no ethical approval was needed for this study. Moreover, the analysis used anonymous data that were obtained after each patient agreed to the operation by written consent.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent for the operation.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniël Haverkamp, MD, PhD, Doctor, Postdoc, Surgeon, Department of Orthopedic Surgery, Xpert Orthopedie Amsterdam/SCORE (Specialized Center of Orthopedic Research and Education), Laarderhoogtweg 12, Amsterdam 1101EA, The Netherlands. d.haverkamp@xpertorthopedie.nl
Received: August 5, 2020
Peer-review started: August 5, 2020
First decision: November 4, 2020
Revised: November 4, 2020
Accepted: November 12, 2020
Article in press: November 12, 2020
Published online: January 18, 2021
Abstract
BACKGROUND

In press-fit total hip arthroplasty (THA) ceramic-on-ceramic (CoC) bearings are a potential for overcoming the wear that is seen in ceramic-on-polyethylene (CoPE) bearings, and can lead to wear-induced osteolysis, resulting in loosening of the implant. However, CoC bearings show disadvantages as well, such as squeaking sounds and being more fragile, which can cause ceramic head or liner fracture. Because comparative long-term studies are limited, the objective of this study was to determine the long-term difference in wear, identify potential predictive factors for wear, investigate radiological findings such as osteolysis, and evaluate clinical functioning and complications between these bearings.

AIM

To determine 10-year differences in wear, predictive factors for wear, and investigate radiological findings and clinical functioning between CoC and CoPE.

METHODS

This observational prospective single-center cohort study with a 10-year follow-up includes a documented series of elective THAs. Primary outcome was wear measured by anteroposterior (AP) radiographs. Secondary outcomes were potential predictive factors for wear, complications during follow-up, Harris hip score (HHS), and radiological findings such as presence of radiolucency, osteolysis, atrophy, and hypertrophy around the cup. Due to the absence of wear in the CoC group, stratified analysis to identify risk factors for wear was only performed in the CoPE group by use of univariate linear regression analysis. HHS was expressed as a change from baseline and the association with bearing type was assessed by use of multivariate linear regression analysis, adjusted for potential confounders.

RESULTS

A total of 17 CoPE (63.0%) and 25 CoC (73.5%) cases were available for follow-up and showed a linear wear of respectively 0.130 mm/year (range 0.010; 0.350) and 0.000 mm/year (range 0.000; 0.005), which was significant (P < 0.001) between both groups. Wear always occurred in the cranial direction. Cup inclination was the only predictive factor for polyethylene (PE) wear. No dislocations, ceramic head, or liner fractures were seen. The HHS showed a mean change from baseline of 37.1 points (SD 18.5) in the CoPE group and 43.9 (SD 17.0) in the CoC group. This crude difference of 6.8 (range -5.2; 18.7) in favor of the CoC group was not significant (P = 0.26) and was not significant when adjusted for age, gender, and diagnosis either (P = 0.99). No significant differences in complications and radiological findings were seen between groups.

CONCLUSION

CoC bearing shows lower wear rates compared to CoPE at 10-year follow-up with cup inclination as a predictive factor for wear and no differences in complications, HHS, and radiological findings.

Keywords: Total hip arthroplasty, Press-fit, Bearing, Ceramic-on-ceramic, Ceramic-on-polyethylene, Wear

Core Tip: Polyethylene wear of the acetabular insert can cause osteolysis and aseptic loosening of the implant in total hip arthroplasty. Ceramic-on-ceramic (CoC) bearing can overcome this problem, but comparative long-term data between ceramic-on-polyethylene (CoPE) and CoC are limited. This 10-year follow-up study showed higher wear rates in CoPE with cup inclination as a predictive factor for wear. No differences in complications, radiological findings, and clinical scores were seen. To confirm the potential benefits of CoC bearing focusing on wear and survival rates of the implant, more long-term data are needed.