Long-term results of alumina ceramic-on-ceramic bearings in cementless total hip arthroplasty: a 20-year minimum follow-up.

Abstract Background Alumina ceramic-on-ceramic (CoC) bearings are used in total hip arthroplasty (THA) due to their wear-resistant and inert properties. In this study, we assessed the clinical and radiographic outcomes of patients undergoing primary cementless CoC THA at a minimum follow-up of 20 years. Methods A series of 301 consecutive primary THAs in 283 patients were assessed. Clinically, patients were assessed with the modified Harris Hip Score (HHS) and pain questionnaires. Anteroposterior radiographs of the pelvis and lateral radiographs of the hip were used to radiologically assess the implant. Patients were classified as lost to follow-up if they could not be contacted on multiple occasions or did not wish to participate further in this study. Results At twenty years post-operation, 60 patients had died of a cause unrelated to surgery, 16 had experienced complications requiring reoperation and 100 hips had both clinical assessments and radiographs at a minimum of 20 years follow-up. The average HHS improved from 56.1 (range:17-89) pre-THA to 92.5 (range:63-100) at latest follow-up. Classification of the HHS was good or excellent in 96.4% of patients. Only 1.8% of patients still had moderate residual pain at the thigh or groin. Radiographically, all patient demonstrated bony ingrowth no clinical symptoms of loosening. The overall survival rate of the implants was 94.2% at 20 years with revision for any reason as the end point. Conclusions Long term follow-up in our series showed excellent implant survival, functional outcomes and minimal late complications. There was no significant radiographic evidence of failure at a minimum of 20 years post-THA.