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Randomized Controlled Trial
. 2024 Nov;34(6):701-716.
doi: 10.1177/11207000241265653. Epub 2024 Aug 19.

Comparison of 5-year cup and stem migration between ceramic-on-ceramic and ceramic-on-polyethylene bearing in press-fit total hip arthroplasty: a randomised controlled trial using radiostereometric analysis

Amanda D Klaassen  1   2 , Justin van Loon  1   3   4 , Nienke W Willigenburg  1 , Lennard A Koster  2 , Bart L Kaptein  2 , Victor P M van der Hulst  5 , Daniel Haverkamp  3 , Dirk Jan F Moojen  1 , Rudolf W Poolman  1   2
Affiliations
Randomized Controlled Trial

Comparison of 5-year cup and stem migration between ceramic-on-ceramic and ceramic-on-polyethylene bearing in press-fit total hip arthroplasty: a randomised controlled trial using radiostereometric analysis

Amanda D Klaassen et al. Hip Int. 2024 Nov.

Abstract

Introduction: The inelasticity of ceramic bearings might affect primary stability and migration of implants in press-fit total hip arthroplasty (THA). This randomised controlled trial compares migration patterns of the uncemented Delta-TT cup and H-MAX S stem between ceramic and polyethylene liners, up to 5 years follow-up.

Methods: Patients receiving primary press-fit THA were randomly allocated to a ceramic (n = 28) or polyethylene (n = 25) liner. Migration was measured using model-based radiostereometric analysis (RSA) at baseline and 1.5, 3, 6, 12, 24 and 60 months postoperatively and compared between groups using mixed models statistical analysis. The focus of this study is on the 2- to 5-year migration of the Delta-TT cup and migration during complete follow-up of the H-MAX S stem up to 5-years.

Results: At 5-year follow-up, mean (95% CI) proximal cup translation was 0.56 (0.37-0.74) mm in ceramic and 0.58 (0.25-0.90) mm in polyethylene (p = 0.729). The mean change in adduction was 1.05° (0.27-1.82°) in ceramic and 0.78° (-0.16-1.71°) in polyethylene. Mixed modelling showed that all between-group effects were ⩽0.20 mm for translation and ⩽0.22° for rotation at 5 years postoperatively (p ⩾ 0.23). Mean cup migration between 2 and 5 years was limited (all parameters <0.17 mm and <0.30°). At 5-year follow-up, mean stem subsidence was 2.09 mm (0.89-3.29 mm) in ceramic and 2.55 (0.97-4.12) mm in polyethylene. The mean change in internal rotation was 3.69° (1.98-5.40°) in ceramic and 4.01° (2.20-5.81°) in polyethylene. Most stem migration occurred up to 1.5 months, stabilising afterwards. All between-group effects were ⩽0.75 mm for translations and ⩽1.41° for rotations (p ⩾ 0.26).

Conclusions: 5-year migration patterns of press-fit cups and stems were similar between ceramic and polyethylene liners. The Delta-TT cup and H-MAX S stem showed secondary stabilisation and remained stable up to 5 years in both groups, which is promising for long-term survival with both liner types.

Clinical trial registration: ClinicalTrials.gov (NCT03093038).

Keywords: Ceramic; migration; polyethylene; radiostereometric analysis; total hip arthroplasty.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RWP: receives speaker fees and research support from LimaCorporate and Waldemar Link GmbH & Co. KG. All other authors declare that there are no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flowchart of patient selection.
Figure 2.
Figure 2.
Mean (SD) improvement in patient-reported outcomes (PROMs) in the 2 study groups throughout the 5-year follow-up period.
Figure 3.
Figure 3.
Mean (SD) translation and rotation of the Delta TT cup with a polyethylene (PE) or ceramic (CE) liner over time.
Figure 4.
Figure 4.
Mean (SD) translation, rotation and MTPM of the H-MAX S stem with a polyethylene (PE) or ceramic (CE) liner over time.
Figure 5.
Figure 5.
Correlation between total translation of the cup versus the stem.
Appendix 1.
Appendix 1.
Individual translation patterns of the cup with a ceramic liner (left) or polyethylene liner (right).
Appendix 2.
Appendix 2.
Individual rotation patterns of the cup with a ceramic liner (left) or polyethylene liner (right).
Appendix 3.
Appendix 3.
Individual translation patterns of the stem with a ceramic liner (left) or polyethylene liner (right).
Appendix 4.
Appendix 4.
Individual rotation patterns and pattern of Maximum Total Point Motion (MTPM) of the stem with a ceramic liner (left) or polyethylene liner (right).
See this image and copyright information in PMC

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