THA in the under twenties: Ceramic-on-Ceramic as the treatment of choice
An objective of this study was to examine potential differences in complication and revision rates based on the bearing surfaces, within this younger group.
This retrospective review from the Seoul University Hospital Korea included 65 patients (78 hips) who underwent THA between 1991-2018 at one institution. The mean age of the group was 18.9 (13.3-20.0) and mean follow-up was 13.2 years (5.0-31.2). In most cases, osteonecrosis was the reason for surgery.
29 patients received a metal-on-polyethylene (MoP) bearing, 3 a ceramic-on-polyethylene (CoP) and 46 a ceramic-on-ceramic bearing (CoC). There were no differences in age or BMI between the hard-on-soft and CoC groups.
Survivorship - In this study the survival rate:
▪ With CoC bearings was 97.8% at 10- and 20-years – Neither fracture nor noises were reported
▪ With hard-on-soft bearings (MoP and CoP) was 59.9% at 10-years, and 36.7% at 20-years
▪ With hard-on-soft bearings remained at 36.7% at 31-years
The authors suggest that the lower rates might be attributed to the extended follow-up and the use of traditional polyethylene. Certain limitations were also acknowledged including, small sample size, confounding variables including surgical approach and different implants, and the location of the study in an East Asian country where squatting and sitting on the floor are common and could have increased the frequency of polyethylene wear. The activity levels of patients were also not known and could also have impacted implant wear and longevity. There were no ceramic fractures or noise reported.
In this cohort CoC showed excellent survivorship and was recommended by the authors as the preferred surface option in THA.
📚 Kang SW, Ko YS, Hong Seok Kim, Jeong Joon Yoo. Outcome and complication rate of total hip arthroplasty in patients younger than twenty years: which bearing surface should be used? International Orthopaedics. Published online January 13, 2024. https://link.springer.com/article/10.1007/s00264-023-06086-0