• AHP-MOORA
• ceramic
• hip implant composites
• optimisation
• physicomechanical

Total hip arthroplasty (THA) with ceramic-on-ceramic (CoC) was created to minimise wear debris and aseptic loosening. A decade ago, a meta-analysis showed a 10-year survival rate of just 89%. Based on the excellent tribology of the current CoC, significant improvement of implant survivorship is expected. In patients younger than 60, we conducted a meta-analysis to assess 10-year survival and complications after using current primary CoC THA.

PubMed, Scopus, EMBASE, Virtual Health Library, and Cochrane Library were used to scan for published trials that met the inclusion criteria until January 2019. The qualified studies were subjected to a systematic review and proportional analysis, and the randomised controlled trials (RCTs) were included in a comparison meta-analysis.

Thirteen studies were included 156 findings. The total number of hips was 2278. Nine studies were cohort, and four were RCTs between ceramic and polyethylene cups. The analysis revealed an average age of 44 years (range 24–54). The 10-year survival 96% (95% CI; 95.4–96.8%), aseptic loosening rate 0.516. (95% CI; 0.265–0.903), ceramic fracture rate 0.620 (95% CI; 0.34–1.034) and squeaking rate 2.687 (95% CI; 1.279–4.593). A comparison meta-analysis revealed the risk ratio (RR) for revision was 0.27 (95% CI; 0.15–0.47), and for aseptic loosening 0.15 (0.03–0.70) favouring CoC, while RR for component fracture was 1.62 (95% CI; 0.27–9.66) favouring the polyethylene.

In patients under sixty, current CoC THAs are correlated with better 10-year outcomes than before and have high survivorship rates.

Level of evidence: Level I.

• Arthroplasty
• Ceramic
• Hip
• Non-elderly

• ceramic
• hip
• hip prosthesis
• orthopedics
• osteoarthritis
• total hip replacement

Although ceramic-on-ceramic (CoC) bearings have been shown to produce the smallest amount of wear volume in vitro as well as in vivo studies when used for total hip arthroplasties (THA), concerns about the failure of these bearing surfaces persist due to early failures observed after short postoperative time. In this study, an exhaustive analysis of the early failure occurred on the new generation of ceramic bearings, consisting of a composite alumina matrix-based material reinforced with yttria-stabilized tetragonal zirconia (Y-TZP) particles, chromium dioxide, and strontium crystals, was performed. For this study, 118 CoC bearings from 117 patients were revised. This article describes a group of mechanical failure CoC-bearing BIOLOX THA hip prosthesis patients without trauma history. The retrieved samples were observed under scanning electron microscopy (SEM), composition was analyzed with energy dispersive X-ray spectroscopy (EDX), and damaged surfaces were analyzed by grazing-incidence X-ray diffraction (GI-XRD) and white light interferometry. In the short term, CoC articulations provided similar mechanical behavior and functional outcome to those in XLPE cases. However, 5% more early mechanical failures cases were observed for the ceramic components. Although the fracture rate of third generation CoC couples is low, the present study shows the need to further improve the third generation of CoC-bearing couples for THA. Despite the improved wear compared to other materials, stress concentrators are sources of initial crack propagation, such as those found in the bore-trunnion areas. Moreover, in view of the evidence observed in this study, the chipping observed was due to the presence of monoclinic phase of the Y-TZP instead of tetragonal, which presents better mechanical properties. The results showed that total safety after receiving a THA is still a goal to be pursued.

• acetabular cup
• catastrophic fracture
• ceramic-on-ceramic
• chipping
• fatigue
• fractographic analysis
• postoperative fracture
• squeaking
• total hip replacement (THR)
• yttria-stabilized tetragonal zirconia (Y-TZP)

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Both arthrotomy debridement only or followed by total hip replacement could be an option in treating synovial chondromatosis of the hip.

Synovial chondromatosis is an unusual nonneoplastic condition of joints. Clinical symptoms usually insidious, and the patient often came in the late stage of the disease. Treatment generally include arthroscopy debridement, open arthrotomy debridement to evacuate loose bodies, or in a very late stage with a collapsing joint, it might need a joint replacement arthroplasty.

We report two cases of a 55-year old and a 22-year-old man with synovial chondromatosis of the hip. Both patients came with hip pain, but the former presents at a late stage with osteoarthritis of the hip. The former underwent open arthrotomy debridement to evacuate loose bodies, synovectomy then followed by a total hip replacement. The latter underwent open arthrotomy debridement only to evacuate loose bodies and synovectomy without performing dislocation of the hip. Postoperative outcome was evaluated using plain hip x-ray, pain scale with VAS, and functional score with Harris Hip Score (HHS).

At 1-year follow up, both subjects demonstrate an improving functional outcome. The former patient had an improved HHS from 39 to 91 while the latter had an improved HHS from 68 to 93. With complete removal of the metaplastic tissue and synovectomy, the recurrence of the chondromatosis is not apparent yet until now.

Arthrotomy debridement only or arthrotomy debridement followed by total hip replacement can be considered as an option in treating synovial chondromatosis of the hip as both show a successful outcome. A selective method of treatment must be considered in our decision making for each individual.

• Case report
• Loose bodies
• Open arthrotomy debridement
• Osteoarthritis
• Synovial chondromatosis
• Total hip replacement

• Arthroplasty
• Hypersensitivity reaction
• Implant material

• Arthroplasty
• Biotribology
• Friction
• Hip
• Lubrication
• Replacement
• Wear