Ceramic-on-ceramic bearings have shown excellent long-term
outcomes, with no osteolysis or adverse biological effects, according to
Laurent Sedel, MD, of Hopital Lariboisiere, University Denis Diderot Paris.
Sedel presented an overview of ceramic-on-ceramic hip bearings and a
20-year study on the coupling at the
SICOT XXV Triennial World Congress 2011.
“The advantages of ceramic-on-ceramic are great,” Sedel said.
“This couple does not present any biological adverse effects, no allergic
response, no elevation of chromium or cobalt in the blood and no problems
regarding pregnancy or renal insufficiency.”
In a 20-year follow-up study, Sedel contacted all of his surviving
patients who had
ceramic-on-ceramic total hip arthroplasties (THAs) and had
them assessed by an independent observer who evaluated the group using the
Merle D’Aubigne score.
“Overall survivorship is 88% at 20 years,” Sedel said in his
presentation at SICOT. “If you look at failures related only to materials,
it is 91% at 20 years.”
The main reason for revision was
aseptic loosening of the acetabular component. Other
complications included two component fractures, one each for the head and
Sedel recalled that in the 1970s, Pierre Boutin, MD, — the first to
implant such a material — experienced problems with ceramic-on-ceramic,
which included fractures and difficulty in ensuring the bond between the
ceramic and metal.
Sedel’s team worked with German researchers to create a taper lock
design to solve this problem. In 1977, Sedel and his team implanted the first
ceramic THA with a cemented socket.
Sedel and his team realized the ceramic material was not perfect and may
pose a fracture risk. They worked with Ceraver Company to improve the design,
choosing a larger size for the ceramic head.
Sedel then discovered complications related to the fixation of the
socket. The team’s first solution to this problem was to use metal
backings with a screw-in design, but this gave rise to some failures. The team
then modified the bearing in 1989 to a press-fit design. After this
modification, results improved dramatically, Sedel said.
Thirty-four years ago, Sedel introduced a cemented stem made of a
titanium alloy and covered with titanium oxide. The survivorship of these stems
was 99% at 10 years and 96% at 20 years, Sedel said.
The initial design of
the device in a patient operated approximately 30 years ago is shown here.
Image: Sedel L
During a 38-year period, Sedel and his team noted more loosening of the
acetabular component in elderly patients.
“In the elderly, we observed more failures that we attributed to
the hardness of the material implanted in osteoporotic bone,” Sedel said.
“It was then that we changed our strategy and began using this material
only for young and active patients.”
Ten years ago, Sedel began to push for the use of ceramic bearings in
“Some patients, even at 75 years old, are included if they are
still active and performing or willing to perform some sports,” Sedel
The risks of metal debris prompted Sedel to use alumina-on-alumina
bearings for THAs instead of metal-on-polyethylene designs. He allows patients
who have had an alumina-on-alumina THA to perform strenuous activities without
limitations. Fracture risk of these bearings is low, Sedel said, with less than
one in 2,000 patients at 10-year follow-up.
Researchers have reported audible contact noise in 10% of patients,
“but it was limited in time and intensity and was never a reason for
revision,” according to Sedel. – by Renee Blisard
- Sedel L. International Hip Society Symposium: Bearng couples.
Ceramic-ceramic. Presented at the SICOT XXV Triennial World Congress 2011.
Sept. 6-9. Prague.
- Laurent Sedel, MD, can be reached at Hopital Lariboisiere,
University Denis Diderot Paris, France; email:
- Disclosure: Sedel is a consultant for Ceraver Company.
Wear and osteolysis are the most concerns for long-term survival in
total hip arthroplasty. Nowadays, metal-on-metal articulations for both
resurfacing hip replacement and total hip replacement are faced with more than
expected clinical failure rates and wear related to soft tissue reactions.
Therefore, ceramic-on-ceramic articulations have gained more importance and
clinical use in the last years.
The data presented by Prof. Sedel show excellent long-term survival of
his ceramic articulation, despite the fact that this was not the high quality
standard ceramics we have nowadays. Delta ceramic has especially gained
increasing use as improvement of the ceramic material allows larger femoral
heads and reduces the risk of ceramic fracture dramatically.
Prof. Sedel’s data are stimulating the use of this hard-on-hard
bearing articulation, which is now accepted worldwide as material with optimal
wear characteristics to achieve excellent long-term clinical results.
— Karl Knahr, MD
Europe Editorial Board member
Vorstand der Abteilung Orthopädie
Orthopädisches Spital Speising GmbH
Disclosure: Knahr has no relevant financial disclosures.