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Long-Term Durability Observed With Alumina-on-Alumina Hip Replacement for Osteonecrosis

Absence of osteolysis can be expected for as many as 24 years after patients with osteonecrosis (ON) of the femoral head undergo alumina-on-alumina hip replacement.

Implant long-term durability is a challenge in total hip replacement for ON. Multiple factors may have a negative impact, including the cause of the disease, extensive and bilateral hip involvement, poor bone quality, previous surgery, young age, and high activity level.

To determine if alumina-on-alumina bearings in total hip replacement could provide effective prevention of osteolysis in young patients with ON of the femoral head, Christophe Nich, MD, and colleagues, Hôpital Lariboisière, Université Paris VII, France conducted a long-term review of 52 consecutive alumina total hip arthroplasties performed for 41 patients with ON.

Patients included in the study had late stage ON with a significant amount of flattening of the articular surface. Their mean age at surgery was 41 years (range 22 - 79) and most had a high activity level. A total of 39 procedures were performed in patients younger than 50 years.

The surgeons used cemented femoral stems with a 32-mm alumina head, and plain alumina cups were either cemented (39 hips) or press-fit (13 hips). Serial anteroposterior and lateral radiographs were taken of each hip prior to and immediately after surgery, 6 weeks after hospital discharge, and at 3 months, 6 months, 1 year, and every 2 years thereafter.

At the time of follow up, 33 patients were alive. Among these, 21 patients (27 hips) had not had acetabular or femoral revision and 12 patients (16 hips) had revision of either one or both components. Eight patients had died of unrelated causes.

All patients had good to excellent clinical results, with no abnormalities seen on radiographs. Ceramic wear and osteolytic lesions were undetectable.

Aseptic loosening of the socket was observed as the main cause of failure. With revision of either component for aseptic loosening as the end point, the cumulative survival rate at 10 years was 88.5% (range 79% - 98%) and 68% (range 52.3% - 83.7%) at 16 years.

"We now are working on socket fixation improvement using a press-fit metal-backed Ti shell either covered by a grid (since 1989) or coated with HA (since 1997)," the researchers note.
Clin Orthop. 2003 Dec;417:102-111. "Long-Term Results of Alumina-on-Alumina Hip Arthroplasty for Osteonecrosis"

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