Incidence, Risk Factors, and Outcome of Ceramic-On-Ceramic Bearing Breakage in Total Hip Arthroplasty

Wayne Hoskins; Sophia Rainbird; Yi Peng; Michelle Lorimer; Stephen E Graves; Roger Bingham

doi:10.1016/j.arth.2021.03.021

Incidence, Risk Factors, and Outcome of Ceramic-On-Ceramic Bearing Breakage in Total Hip Arthroplasty

J Arthroplasty. 2021 Aug;36(8):2992-2997. doi: 10.1016/j.arth.2021.03.021. Epub 2021 Mar 13.

Authors

Wayne Hoskins¹, Sophia Rainbird², Yi Peng³, Michelle Lorimer³, Stephen E Graves⁴, Roger Bingham⁵

Affiliations

¹ Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Traumaplasty.Melbourne, East Melbourne, Victoria, Australia.
² Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.
³ South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
⁴ Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
⁵ Traumaplasty.Melbourne, East Melbourne, Victoria, Australia; Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Victoria, Australia.

PMID: 33812710
DOI: 10.1016/j.arth.2021.03.021

Abstract

Background: Ceramic-on-ceramic bearing breakage is a rare but significant complication of total hip arthroplasty. This study aimed to identify risk factors for breakage and to determine the outcome of different revision options.

Methods: All ceramic-on-ceramic primary total hip arthroplasty procedures reported to the Australian Joint Replacement Registry from September 1999 to December 2019 were included. Procedures were subdivided into alumina or mixed ceramic (alumina/zirconia). All breakages were identified. The association between ceramic type and head size was assessed. Subsequent revision rates were compared and cause of revision assessed.

Results: There were 23,534 alumina and 71,144 mixed ceramic procedures. Breakage was the reason for 1^st revision in 84 alumina (5.27% of all revisions and 0.36% of procedures) and 56 mixed ceramic procedures (2.46% of all revisions; 0.08% of procedures). Alumina had a higher breakage rate than mixed ceramic (HR 2.50 (95% CI 1.75, 3.59), P < .001), and breakage was higher for 36-38mm head sizes using alumina (HR 2.84 (1.52, 5.31), P = .001). 17.8% of 2^nd revisions occur by 3 years, due to dislocation, infection, metal-related pathology, and loosening. A neck adapter sleeve did not reduce 2^nd revisions. Numbers were too low to compare revision bearing surface options.

Conclusion: Ceramic breakage has reduced with mixed ceramics but has a 0.79/1000 incidence at 15-year follow-up. It is unclear what the risk factors are for modern ceramics with increasing head size a risk for alumina only. Risk of 2^nd revision is high and occurs early. The optimal revision option is unknown.

Keywords: ceramic; hip; hip prosthesis; orthopedics; osteoarthritis; total hip replacement.

MeSH terms

Arthroplasty, Replacement, Hip* / adverse effects
Australia
Ceramics
Hip Prosthesis* / adverse effects
Humans
Incidence
Prosthesis Design
Prosthesis Failure
Reoperation
Risk Factors
Treatment Outcome