Clinical Orthopaedics and Related Research: February 2012 - Volume 470 - Issue 2 - p 382–387 doi: 10.1007/s11999-011-2161-y Symposium: Papers Presented at the Annual Meetings of The Hip Society

Causes of Failure of Ceramic-on-Ceramic and Metal-on-Metal Hip Arthroplasties

Porat, Manny, MD1; Parvizi, Javad, MD, FRCS1; Sharkey, Peter, F., MD1; Berend, Keith, R., MD2; Lombardi, Adolph, V., Jr, MD, FACS2; Barrack, Robert, L., MD3, a

Background Few large series of hard bearing surfaces have reported on reasons for early failure. A number of unique mechanisms of failure, including fracture, squeaking, and adverse tissue reactions, have been reported with these hard bearing surfaces. However, the incidence varies among the published studies.


Questions/purposes To confirm the incidences, we identified the etiologies of early failures of hard-on-hard bearing surfaces for ceramic-on-ceramic and metal-on-metal THAs.


Methods We retrospectively reviewed records of 2907 THAs with hard-on-hard bearing surfaces implanted between 1996 and 2009; 1697 (58%) had ceramic-on-ceramic and 1210 (42%) had metal-on-metal bearing surfaces. We recorded bearing-related complications and compared them to nonspecific reasons for revision THA. The minimum followup of the ceramic-on-ceramic and metal-on-metal cohorts was 6 months (mean, 48 months; range, 6-97 months) and 24 months (mean, 60 months; range, 24-178 months), respectively.


Results The overall revision rate for ceramic-on-ceramic THA was 2.2% (38 of 1697), with aseptic loosening accounting for 55% of revisions (femur or acetabulum). The bearing accounted for 13% of the revisions in the ceramic-on-ceramic THA cohort. The overall metal-on-metal revision rate was 5.4% (65 of 1210), 17 involving adverse tissue reactions related to the metal-on-metal bearing surface (17 of 1210, 1.4% of cases; 17 of 65, 26% of revisions).


Conclusions Twenty-six percent of the revisions from metal-on-metal and 13% of ceramic-on ceramic were bearing related. The overall short- to medium-term revision rate was 2.2% and 5.4% for ceramic-on-ceramic and metal-on-metal, respectively. The most common etiology of failure was loosening of the femoral or acetabular components.


Level of Evidence Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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