BACKGROUND: Ceramic bearings were introduced to reduce wear and increase long-term survivorship of total hip arthroplasty. In a previous study comparing ceramic with metal-on-polyethylene at 5 to 8 years, we found higher survivorship and no osteolysis for the ceramic bearings.QUESTIONS/PURPOSES: We asked whether ceramic bearings have equal or superior survivorship compared with that for metal-on-polyethylene at longer followup; we also determined survivorship of the implant systems, the presence or absence of radiographic osteolysis, and incidence of device squeaking.METHODS: Five surgeons at five sites have followed 189 patients (216 hips) for a minimum of 10 years and average of 10.3 years (range, 10-12.4 years) comparing alumina ceramic bearings (144 hips) with cobalt chrome-on-polyethylene bearings (72 hips). We determined Kaplan-Meier survivorship of the bearing surface and implant systems and collected radiographic and clinical data.RESULTS: We observed no difference between the control metal-on-polyethylene and the alumina-bearing couple cohorts with regard to bearing-related failures (98.9% versus 99.1%). Revisions for any reason occurred in 10.5% of the control patients and 3.1% of the patients with alumina bearings. All femoral implants remain well fixed (100%), whereas one acetabular component (1%) is unstable in the control group. Osteolysis occurred in 26% of the control patients and in none of the patients with alumina bearings. Squeaking occurred in two of 144 hips (1.4%) of the patients with ceramic bearings.CONCLUSIONS: Patients receiving the ceramic-on-ceramic bearings had fewer revisions for any reason and less osteolysis than the control metal-on-polyethylene at 10 years. Our data suggest ceramic bearings continue to provide an option for the young and more active patient and provide for a measure to compare other new alternative bearings that are currently available.LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Adult Aged