Total Hip Arthroplasty Using Hybrid Ceramic Bearing: A Minimum 10-Year Followup Study

BACKGROUND: Contemporary ceramic articulation in total hip arthroplasty (THA) has shown successful clinical and radiologic outcomes at mid-to-long term. Delta ceramic, which includes 24% zirconia, has been developed to reduce the rate of ceramic fracture. However, the phase transformation of the zirconia that might cause surface roughness, ceramic wear, and subsequent osteolysis remains a concern. The purpose of this study was to evaluate clinicoradiological outcomes, ceramic-related complications, and survivorship of THA with the use of hybrid ceramic bearing; BIOLOX delta liner-on-BIOLOX forte head articulation at a minimum followup of 10 years. MATERIALS AND METHODS: One hundred cementless THAs (85 patients) were performed with the use of 36-mm hybrid ceramic bearing. The thickness of the delta ceramic liner was 4–6 mm. Four patients (4 hips) were lost and six patients (6 hips) died within 10 years after the operation. Thus, the remaining 75 patients (90 hips) were followed up for 10–12 years. There were 43 men and 32 women. The mean age of these patients at the index operation was 58 years (21–78 years). RESULTS: There were no fractures of ceramic liner or head. There was no measurable ceramic wear, and neither pelvic nor femoral osteolysis was identified. All acetabular and femoral components were bone-ingrown. Three (3/90, 3.3%) patients noted noise of clicking sound. The mean Harris hip score was 87 points (range 72–99 points) at the time of final followup. THA survivorship with revision surgery as an endpoint was 97.8% (95% confidence interval: 91.4%–99.8%). CONCLUSIONS: The long term result of cementless THA with the use of a large BIOLOX forte head on the BIOLOX delta liner showed an encouraging result. Wear or osteolysis associated with composite of 24% zirconia in the fourth-generation ceramic was not observed at a minimum followup of 10 years.