Incidence, Risk Factors And Outcomes of Ceramic-On-Ceramic B
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Ceramic-on-ceramic (CoC) bearing breakage is a rare but significant complication of total hip arthroplasty (THA). Ceramic breakage has decreased with mixed ceramics, but it still occurs at a rate of 0.79/1000, finds Study. To determine the outcome of different revision options & identify risk factors for breakage, a Study was conducted.

Methods
All CoC primary THA procedures reported to the Australian Joint Replacement Registry from September 1999 to December 2019 were included. Procedures were subdivided into alumina or mixed ceramic (alumina/zirconia). All breakages were identified. The association between ceramic type and head size was assessed. Subsequent revision rates were compared and cause of revision assessed.

Results:
--There were 23,534 alumina and 71,144 mixed ceramic procedures.
--Breakage was the reason for 1st revision in 84 alumina (5.27% of all revisions; 0.36% of procedures) and 56 mixed ceramic procedures (2.46% of all revisions; 0.08% of procedures).
--Alumina had a higher breakage rate compared to mixed ceramic (HR 2.50) and breakage was higher for 36-38mm head sizes using alumina (HR 2.84).
--17.8% of 2nd revisions occur by 3 years, due to dislocation, infection, metal related pathology and loosening.
--A neck adapter sleeve did not reduce 2nd revisions. Numbers were too low to compare revision bearing surface options.

In conclusion, ceramic breakage has decreased with mixed ceramics, but it still occurs at a rate of 0.79/1000 after a 15-year follow-up. The risk factors for modern ceramics are uncertain, with growing head size being a risk only for alumina. The probability of a second revision is strong, and it occurs early. The best revision strategy is uncertain.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0883540321002618?dgcid=rss_sd_all
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