Abstract
Background The use of Ceramic-on-Ceramic (CoC) bearings in primary total hip arthroplasty (THA)
is increasing and has been intensively analysed. This bearing plays a particularly
relevant role in young, active patients and shows advantages over other bearings in
biocompatibility, wear rate and lubrication properties. On the contrary, CoC bearings
in revision THA are seldom used and scarcely analysed. The aim of this study is to
systematically review the available literature on CoC bearings in revision THA.
Methods A systematic research in the English literature was performed to identify all studies
reporting results of THA revisions using ceramic-on-ceramic bearing. The initial search
strategy revealed 555 articles for consideration. On the basis of eligibility criteria,
26 studies were included in this review.
Results Twenty-six studies, accounting for 1846 procedures, were eligible and included in
the review. No studies of Level I were identified. Eighteen studies reported on revisions
of CoC implants for various reasons, performed either with CoC or different bearings.
In 111 patients a CoC bearing was used for the revision. Six studies consistently
reported outcome measures for CoC bearing THA revisions, so that a quantitative synthesis
of the data was possible. The range of follow-up across the six studies varied between
2.1 and 19 years, with a cumulative avearage follow-up of 9.3 years. A good functional
result was documented, with a cumulative weighted mean for postoperative Harris Hip
Score (HHS) of 87 points. The rate of dislocation in this group was 3.45% and the
risk of fracture of an alumina ceramic head was 0.35% (1 study). Squeaking was reported
as complication of CoC bearing THA revisions in three studies, with a calculated incidence
of 0.52%.
Conclusion Modern CoC bearings show advantages in preclinical and retrospective studies over
other bearings also in revision cases and are therefore to be considered a promising
alternative for this kind of operation. Reasonable indications for CoC bearing in
revision THA are revisions for aseptic loosening or recurrent dislocation in young
patients, fractures of ceramic components, large acetabular defects or in patients
that are allergic to bone cement components. Nevertheless, prospectively designed
or randomized studies are lacking and needed to confirm CoC as optimal solution for
revision THA cases.
Key words
revision arthroplasty - ceramic-on-ceramic bearing - bearing surface - meta-analysis
