Long-Term Outcomes of Third-Generation Ceramic-on-Ceramic Bearings in Cementless Primary Total Hip Arthroplasty: A 25-Year Survival Analysis.

Abstract

The demand for total hip arthroplasty (THA) in younger patients, particularly those under 65 years, has increased markedly in recent years. Ceramic-on-ceramic (CoC) bearings offer promising benefits, including reduced wear and osteolysis, with excellent short- to mid-term survival. However, long-term data on their performance in younger populations remain limited. This study aimed to investigate: (1) overall implant survival, (2) complications and reasons for revision, and (3) patient-reported outcomes at long-term follow-up after primary THA with third-generation CoC bearings. A retrospective analysis was performed on 231 patients (294 hips) who underwent cementless THA with third-generation CoC bearings between May 1999 and September 2004. The mean age at surgery was 50 years (range, 17 to 76). Clinical and radiographic outcomes were assessed at a minimum follow-up of 10 years, and the mean follow-up was 17 years (range, 10 to 25). Overall, 87 patients (108 hips, 38%) were lost to follow-up, leaving a total of 145 patients (186 hips) for further analysis. Kaplan-Meier survival analysis was used to estimate implant survival, with implant revision for any reason defined as a primary end point. Complications, reasons for revision, and patient-reported outcomes (Merle d'Aubigné-Postel score) were also evaluated. Kaplan-Meier analysis demonstrated an implant survival rate of 93% at 25 years. At long-term follow-up, 12 hips (6.5%) required revision for either bearing failure (six hips), acetabular component failure (four hips), or femoral component failure (two hips). There were six cases of hip squeaking (3.2%) reported, none requiring revision. Functional outcomes improved significantly, with mean Merle d'Aubigné-Postel scores rising from 10.7 preoperatively to 17.6 at the final follow-up. Radiographic evaluations showed no cases of osteolysis or loosening. Third-generation CoC bearings in cementless THA offer excellent long-term survival, low complication rates, and good to excellent functional outcomes, highlighting their durability and performance over a 25-year period.