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. 2021 Jun;45(6):1447-1454.
doi: 10.1007/s00264-020-04895-1. Epub 2021 Jan 18.

Ceramic-on-ceramic articulation in press-fit total hip arthroplasty as a potential reason for early failure, what about the survivors: a ten year follow-up

J van Loon  1   2   3 , A M J S Vervest  3 , H M van der Vis  1 , I N Sierevelt  1   4 , D C Baas  3 , K T M Opdam  2 , G M M J Kerkhoffs  2 , D Haverkamp  5
Affiliations

Ceramic-on-ceramic articulation in press-fit total hip arthroplasty as a potential reason for early failure, what about the survivors: a ten year follow-up

J van Loon et al. Int Orthop. 2021 Jun.

Abstract

Purpose: In press-fit total hip arthroplasty (THA), primary stability is needed to avoid micromotion and hereby aseptic loosening, the main reason for early revision. High aseptic loosening revision rates of the seleXys TH+ cup (Mathys Medical) with Ceramys ceramic-on-ceramic (CoC) bearing are seen in literature. Since CoC is presumed to overcome long-term wear-related revisions, the reason for early failure of this cup is important to clarify. The aim is to investigate its ten year outcomes and differentiate between potential causes and identify risk factors for aseptic loosening.

Methods: Retrospective screening of a prospectively documented series of 315 THAs was performed. Primary outcome was cumulative incidence of cup revision due to aseptic loosening. Secondary outcomes were component revision and reoperation. Additionally, potential predictive factors for aseptic loosening were evaluated.

Results: At the median follow-up of 9.7 years [IQR 4.4; 10.3], 48 TH+ (15.2%) were revised due to aseptic loosening. Competing risk analysis showed a ten year cumulative incidence of cup revision due to aseptic loosening of 15.6% (95% CI 12.0-20.2). Stabilization of early revision rates was observed, following a high rate of respectively 81.3% (n = 39) and 95.8% (n = 46) within the first two and three years. No significant predictive factors for aseptic loosening were found.

Conclusion: The ten year results of seleXys TH+ cup with Ceramys CoC bearing showed an unacceptable high aseptic loosening rate, which stabilized over time after a high early failure incidence. This could be attributed to a problem with osseointegration during the transition of primary to definitive stability.

Keywords: Aseptic loosening; Ceramic-on-ceramic; Early failure; Primary stability; Total hip arthroplasty.

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Conflict of interest statement

Daniël Haverkamp declares that he does consultancy work for Mathys Medical and receives research support from Mathys Medical. The rest of the authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Cumulative incidence of cup revision over time, with upper and lower limits of 95% CI
Fig. 2
Fig. 2
Example of a case with aseptic loosening. a Direct post-operative X-ray. b X-ray at 9 months follow-up with clear loosening of the cup
Fig. 3
Fig. 3
Distribution of primary and secondary stability over time. The minimum stability needed for safe fixation is indicated with the red line. In the red area, the cup is at risk for loosening if transition from press fit to definitive stability by osseointegration is jeopardized
Fig. 4
Fig. 4
Macroscopic cup design of the a SeleXys TH+ (Mathys Medical), b Allofit (Zimmer), c Cerafit-R (Ceraver)
See this image and copyright information in PMC

Comment in

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