The Journal of Bone and Joint Surgery (American) 83:1688-1694 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Ceramic-on-Polyethylene Bearing Surfaces in Total Hip Arthroplasty
Seventeen to Twenty-one-Year Results
Joshua A. Urban, MD,
Kevin L. Garvin, MD,
Clifford K. Boese, MD,
Linda Bryson, RN,
Douglas R. Pedersen, PhD,
John J. Callaghan, MD and
Ronald K. Miller, MD
Investigation performed at University of Nebraska Medical Center,
Omaha, Nebraska, University of Iowa, Iowa City, Iowa, and Miller
Orthopaedic Affiliates, Council Bluffs, Iowa
Joshua A. Urban, MD
Kevin L. Garvin, MD
Department of Orthopaedic Surgery and Rehabilitation, 981080
University of Nebraska Medical Center, Omaha, NE 68198-1080. E-mail
address for J.A. Urban: najurban{at}hotmail.com
Clifford K. Boese, MD
Linda Bryson, RN
Ronald K. Miller, MD
Miller Orthopaedic Affiliates, One Edmundson Place, Suite 500,
Council Bluffs, IA 51503-4643
Douglas R. Pedersen, PhD
John J. Callaghan, MD
Department of Orthopaedic Surgery, University of Iowa, 200 Hawkins
Drive, Iowa City, IA 52242
In support of the research or preparation of this manuscript, one
or more of the authors received grants or outside funding from National
Institutes of Health Grant AR43314. In addition, one or more of
the authors received payments or other benefits or a commitment
or agreement to provide such benefits from a commercial entity.
Also, a commercial entity (DePuy Orthopedics/Johnson and
Johnson) paid or directed, or agreed to pay or direct, benefits
to a research fund, foundation, educational institution, or other
charitable or nonprofit organization with which one or more of the
authors are affiliated or associated.
Background: Polyethylene wear debris, and the
resulting inflammatory response leading to osteolysis and loosening,
is the primary mode of failure limiting the longevity of total hip
replacements. Alternative bearing surfaces, including ceramic-on-polyethylene,
have been investigated in an effort to decrease the amount of polyethylene
wear debris. The purpose of this study was to evaluate the seventeen
to twenty-one-year results of the use of ceramic-on-polyethylene
total hip prostheses.
Methods: Sixty-four total hip prostheses were implanted
with cement, by one surgeon, in fifty-six patients from 1978 to
1981. The average age at the index arthroplasty was sixty-nine years (range,
fifty-one to eighty-four years). The components consisted of a cemented
Charnley-Müller stem with a 32-mm modular alumina femoral
head and a cemented all-polyethylene acetabular component. All patients
who retained the index prosthesis were assessed clinically with
use of Harris hip scores and were evaluated radiographically at
the time of the latest follow-up.
Results: At the time of this latest follow-up, of
the original sixty-four implants, eighteen (28%) were still
in place and five (8%) had been revised. The remaining
forty-one implants were in patients who had died and were functioning
well until the patient’s death. No patient was lost to
follow-up. Of the eighteen hips with an intact prosthesis in the
surviving patients, seven had an excellent clinical result; nine,
a good result; and two, a fair result. One asymptomatic hip had
definite radiographic evidence of femoral loosening. No hip had
definite signs of acetabular loosening or evidence of osteolysis.
Survivorship analysis revealed that the probability of survival
of the prostheses without revision was 95% at five years,
95% at ten years, 89% at fifteen years, and 79% at
twenty years. The mean linear and volumetric polyethylene wear rates
were 0.034 mm/yr and 28 mm3/yr,
respectively. There were no fractures of the ceramic heads.
Conclusions: Outstanding long-term clinical and
radiographic results were attained despite the use of what are now
considered substandard techniques (an inferior stem design, a 32-mm
head, and first-generation cementing techniques). The wear rates
in this study are lower than previously reported metal-on-polyethylene
wear rates and are consistent with the lowest reported in
vivo ceramic-on-polyethylene wear rates. These findings
support the consideration of ceramic-on-polyethylene bearing surfaces
in total hip arthroplasty.
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