Minimum 10-Year Follow-Up of Patients 50 Years or less Undergoing Total Hip Arthroplasty Who Have Fourth-Generation Ceramic 32-mm Femoral Heads on Highly Cross-Linked Polyethylene.

BACKGROUND

Total hip arthroplasty (THA) with third-generation alumina ceramic heads on highly cross-linked polyethylene liners (HXLPE) has demonstrated excellent outcomes in young patients. However, there is limited data for fourth-generation ceramic heads. The purpose of our study was to report on clinical and wear, outcomes of THA with fourth-generation 32-mm ceramic femoral heads and HXLPE liners in patients 50 years or younger at 10-year minimum follow-up.

METHODS

This was a retrospective study of 103 THAs with fourth-generation 32-mm ceramic femoral heads on HXLPE between December 2008 and December 2010. The mean age was 37 years (range, 13 to 50). The modified Harris Hip Score, University of California, Los Angeles Activity Score, and Western Ontario and McMaster University Osteoarthritis Index pain score were collected preoperatively and at each follow-up. Martell Hip Analysis was used for wear calculations.

RESULTS

Survivorship from all-cause revision was 97.1% (95% confidence interval (CI), 93.8 to 100.0) at 5 years, 97.1% (95% CI, 93.8 to 100.0) at 10 years, and 95.4% (95% CI, 90.9 to 99.9) at 15 years. Survivorship from wear-related revision was 100% at 15 years. There were four hips (3.9%) that underwent revision at a mean of 5.1 years (range, 0.04 to 13.2) postoperatively. The mean linear wear rate was 0.0184 mm/year (SD ± 0.043); the mean volumetric wear rate was 18.38 mm/year (SD ± 22.55). Improvements were observed in the modified Harris Hip Score (48 ± 16 to 84 ± 22; P < 0.001), University of California, Los Angeles score (5.5 ± 2.3 to 6.2 ± 2.1; P = 0.031), and Western Ontario and McMaster Universities Arthritis Index pain score (45 ± 21 to 86 ± 23; P < 0.001). Patient satisfaction scores were 73% "extremely satisfied" and 13% "very satisfied."

CONCLUSIONS

The fourth-generation ceramic 32-mm femoral heads on HXLPE in THA for patients aged 50 years or younger demonstrate excellent survivorship, minimal wear, and high patient satisfaction at a 10-year minimum follow-up.