Cementless Total Hip Arthroplasty Using a Third-Generation Alumina-On-Alumina Ceramic or Alumina-On-Highly Cross-Linked Polyethylene Bearing: 20-to 30-Year Follow-Up

Abstract

Background: We determined the long-term (>= 20 years) clinical outcomes of metaphyseal-fitting anatomic cementless implants with alumina ceramic-on-ceramic (C-O-C) or alumina ceramic-on-highly cross-linked polyethylene (C-O-HXLPE) bearings. Methods: Consecutive primary total hip arthroplasty (THA) procedures were performed in 250 patients (500 hips; 140 men, 110 women) aged < 65 years. This is a series of bilateral THA patients who were randomized to receive a C-O-C bearing on one side and a C-O-HXLPE on the contralateral side. The mean age at the time of THA was 45 years (range, 31 to 65), with a mean follow-up of 25.5 years (range, 20 to 30). Osteolysis was assessed using radiographs and computed tomography scans, whereas polyethylene wear was measured using a computer software program. Results: There was no hip in either group that had osteolysis. The mean polyethylene penetration rate of the HXLPE liner was 0.041 +/- 0.005 mm/year. The survival rate in the C-O-C bearing group was 96.8% (95% confidence interval [CI], 92 to 100) for the femoral component and 97.2% (95% CI, 92 to 100) for the acetabular component at a mean of 25.5 years of follow-up. In the C-O-HXLPE bearing group, the survival rate for both femoral and acetabular components was 97.6% (95% CI, 92 to 100) at a mean of 25.5 years of follow-up. The clinical and functional results (Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California, Los Angeles, activity score) improved significantly (P < 0.05) at the final follow-up in both groups. Conclusions: At a mean follow-up of 25.5 years, a metaphyseal-fitting anatomic cementless femoral stem with alumina C-O-C or alumina C-O-HXLPE bearings demonstrated excellent long-term function, with no osteolysis and no ceramic femoral head or acetabular liner fractures. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.