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
ARTICLE HIGHLIGHTS
Research background

Ceramic-on-ceramic (CoC) bearing in total hip arthroplasty (THA) is presumed to give lower wear rates in vivo, compared to ceramic-on-polyethylene (CoPE).

Research motivation

More in vivo long-term studies are needed in literature, to confirm potential benefits or disadvantages of CoC over CoPE.

Research objectives

The objective of this study was to determine the 10-year difference in wear, identify potential predictive factors for wear, investigate radiological findings such as osteolysis, evaluate clinical functioning and complications between CoC bearing vs CoPE when using the same implants.

Research methods

An observational prospective single-center cohort study with 10-year follow-up of a documented series of elective THAs was performed with either a ceramic (BIOLOX delta, Smith and Nephew) or a standard PE acetabular insert (Standard REXPOL, Smith and Nephew) with a similar ceramic head (BIOLOX delta, Smith and Nephew) articulation.

Research results

Higher wear rates were observed in CoPE compared to CoC bearing after 10-year follow-up with cup inclination as a predictive factor for wear for CoPE bearing, and no differences in complications, Harris hip score, and radiological findings.

Research conclusions

The potential benefit of CoC over CoPE at the 10-year follow-up is less wear with cup inclination as a predictive factor for wear, without differences in clinical or radiological outcomes.

Research perspectives

Further investigation of wear, revision, and complication rates between CoC and CoPE, especially in the long-term, should be done, to confirm potential benefits of CoC over CoPE and to prove if it can improve the longevity of THAs. In addition, long-term analysis needs to clarify if differences in outcomes, complication, and revision rates are cost-effective to the costs of both bearings.