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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Long-term durability of alumina ceramic heads in THA

BMC Musculoskeletal Disorders > Ausgabe 1/2015
Nicholas A. Beckmann, Tobias Gotterbarm, Moritz M. Innmann, Christian Merle, Thomas Bruckner, J. Philippe Kretzer, Marcus R. Streit
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

NAB conception of study, discussion, statistics, and writing. TG supervision, discussion, and review. MMI planning of study, data collection, and supervision. CM data evaluation, discussion, and review. TB: data review, statistical evaluation. JPK review, statistics and discussion. MRS planning, conception of study, data collection, statistics, review, and discussion. All authors read and approved the final manuscript.



The optimal type of bearing for hip arthroplasty remains a matter of debate. Ceramic-on-polyethylene (CoP) bearings are frequently used in younger and more active patients to reduce wear and increase biocompatibility compared to Metal-on-Polyethylene (MoP) bearings. However, in comparison to metal heads, the fracture risk of ceramic heads is higher. In addition, ceramic head fractures pose a serious complication which often necessitates major revision surgery. To date, there are no long-term data (>20 years of follow-up) reporting fracture rates of the ceramic femoral heads in CoP bearings. The purpose of this research was to investigate long-term CoP fracture rate.


We evaluated the clinical and radiographic results of 348 cementless THAs treated with 2nd generation Biolox® Al2O3 Ceramic-on-Polyethylene (CoP) bearings consecutively implanted between January 1985 and December 1989. The mean age at implantation was 57 years. The patients were followed for a minimum of 20 years. At the final 111 had died, and 5 were lost to follow-up. The cumulative incidence of ceramic head fractures in the long-term was estimated using a competing risk analysis.


The cumulative incidence of ceramic head fracture after 22-years was estimated with a competing risk analysis at 0.29 % after 22-years (SE = 2.09 %; 95 % - CI: 0.03-1.5 %). The radiographic analysis revealed no impending failures at final follow-up.


The fracture rate of second-generation ceramic heads using a CoP articulation remains very low into the third decade after cementless THA.
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