A randomised prospective evaluation of ceramic-on-ceramic and ceramic-on-highly cross-linked polyethylene bearings in the same patients with primary cementless total hip arthroplasty

Purpose: Very few studies have compared alumina-on-alumina ceramic and alumina-on-highly cross-linked polyethylene bearings in the same patient. The purpose of this prospective randomised study was to compare the clinical and radiographic results and the prevalence of osteolysis in cementless total hip arthroplasty using an alumina-on-alumina and alumina-on-highly cross-linked polyethylene bearings in young active patients. Methods: We prospectively compared the results of 100 patients (200 hips) who had undergone a cementless total hip arthroplasty with an alumina-on-alumina ceramic bearing in one hip and an alumina-on-highly cross-linked polyethylene in the other. There were 66 men and 34 women with a mean age of 45.3 years (range, 21-49 years) at the time of surgery. The mean follow-up was 12.4 years (range, 11-13 years). The patients were assessed clinically and radiographically at three months, one year, and annually thereafter. Results: Harris hip, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles activity scores did not show statistically significant differences between the two groups of bearings preoperatively or at the time of final follow-up. Radiographic findings of the component were not significantly different between the two groups. The mean polyethylene linear penetration was 0.031 ± 0.004 mm per year. No hips in either group displayed osteolysis. The Kaplan-Meier survivorship with revision as the end point at 12.4 years was 100 % (95 % confidence interval [CI], 94-100 %) for the femoral component in both groups and 99 % (95 %CI, 93-100 %) for the acetabular component. Conclusion: The clinical and radiographic results of using an alumina-on-alumina ceramic and alumina-on-highly cross-linked polyethylene bearings were similar.