Revision Hip Arthroplasty After Fractured Ceramic Bearings Using Ceramic-on-Ceramic Surfaces: Long-Term Clinical and Radiological Outcomes of 36 Cases.

Abstract

The surgical strategy after fractured ceramic bearings in total hip arthroplasty is still debated. A retrospective case series of prospectively followed ceramic-on-ceramic (COC) revisions after ceramic component fracture was selected, aiming to assess: (1) complications and survival rates, (2) clinical outcomes and noise incidence, and (3) radiological outcomes. There were 36 patients included (all COC total hip arthroplasty). In 83.3% of the patients, an alumina (Forte) component failed: 22 liners, 12 heads (two cases with liner and head failure). In 16.7% of the patients, a zirconia-toughened alumina ceramic (Delta) component failed: one head and five liners. The revision strategy was synovectomy, COC bearings, and fixed component revision in cases of malpositioning/wear. Head revision was performed in 100% of the cases, liner exchange in 91.7%, and cup revision in 50%. After revision, 72.2% of the cases were Delta-on-Delta bearings, 2.78% were Delta-on-Forte, and 25% were Forte-on-Forte. No tribological failures occurred at an average follow-up of 12.2 ± 5.4 years. The 10-year survival rate was 83.7% (95% confidence interval: 65.0 to 100). Re-revisions were due to periprosthetic infection (2.8%) and implant instability (2.8%). At the last follow-up, the mean Harris Hip Score was 85.1 ± 12.6, and the mean Forgotten Joint Score was 69.3 ± 39.3, with 58.3% of excellent outcomes. Postrevision noise was reported in 16.7% of the cohort. No cases of component loosening, migration, or osteolysis were detected. Ceramic debris was detected in 25% of the cases. The COC revisions after ceramic breakage achieved long-term dependable survival rates, with excellent-to-good clinical outcomes and no cases of tribological failures or osteolysis. Level IV, Therapeutic Study.