Purpose: We wanted to evaluate the clinical and radiographic results of ceramic on ceramic bearing cementless total hip arthroplasty with a minimum of 10-years follow up.
Materials and Methods: This study was performed on 44 patients and 51 hips, and the patients were recruited among the patients who underwent ceramic-ceramic type cementless total hip arthroplasty from August 1998 to February 2000 and they were available for 10-years or longer follow up. The gender ratio was 28 males and 16 females, and the mean age at the time of surgery was 49 years (range: 26~77 years). Regarding the causality of disease, osteonecrosis was noted in 36 cases, degenerative arthritis was noted in 4 cases, acetabular dysplasia was noted in 4 cases and septic or tuberculous hip sequelae was noted in 7 cases. The clinical evaluation was performed according to the Harris hip score, and for the radiological evaluation of the femoral component, we assessed the degree of subsidence and the presence of periprosthetic osteolysis, endosteal new bone formation and cortical hypertrophy, and the final fixation state of the implant. In the cases with an acetabular cup osteoscleostic line in the vicinity of the acetabular cup, endosteal new bone formation, acetabular osteolysis and the vertical migration as well as the horizontal migration of the acetubular cup were assessed.
Results: Regarding the clinical outcomes, the Harris hip score was improved from an average 59 points to 93 points at the final follow up. For the radiological results, osteolysis was not detected in the acetabular and femoral components, the subsidence of femoral stem was not beyond 2 mm on average and significant subsidence was not detected. In regard to complications, linear fracture during surgery was noted in 6 cases and postoperative hip dislocation was noted in 1 case. A ceramic head fracture occurred in one case and a ceramic liner fracture occurred in 2 cases.
Conclusion: This type of articulation is a promising option at a minimum of 10-years follow up of 51 hips that underwent ceramic-ceramic bearing cementless total hip arthroplasty. However, our results demonstrated that surgeons should be aware of the potential risks of ceramic fracture when using ceramic-on-ceramic bearing surfaces. Additional longer-term follow-up is necessary.

Keywords: Total hip arthroplasty, Ceramic on ceramic bearing