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AOA NJRR 2025: Ceramic Bearings in the Modern THA Era

The 2025 Australian Registry reflects some consistent realities in primary total hip arthroplasty for osteoarthritis (OA) in Australia: cross-linked polyethylene (XLPE) is widely used (97.2%), cementless fixation dominates, and heads larger than 32mm are the norm.

Graphic highlighting key takeaways on bearing types used in Australia, derived from the 2025 AOA National Joint Replacement Registry (NJRR) report, focusing on bearing performance in total hip arthroplasty.
Graphic showing that XLPE is the standard polyethylene liner material for ceramic‑on‑polyethylene bearing couples and demonstrating that 32 mm femoral heads have a lower revision hazard when used with XLPE liners in total hip arthroplasty.
Graphic presenting key insights from the AOA NJRR 2025 demonstrating universal XLPE use, predominance of cementless fixation, and femoral head sizes above 32 mm as the standard in modern total hip arthroplasty.
Graphic showing AOA NJRR 2025 findings: all CoC implants use mixed ceramic; ≥40 mm heads have the best results; 32 mm heads show a 4.9% 15‑year CPR; and instability revisions decrease from 1.5% with ≤28 mm heads to 0.1% with ≥40 mm heads.
Graphic presenting AOA NJRR 2025 data on ceramic resurfacing, showing 160 ReCerf® procedures performed in 2024 and an exceptionally low 5‑year CPR of 0.4%.

Key bearing takeaways

Longitudinal data reveals a clear performance hierarchy for conventional total hip arthroplasty (THA) over two decades:

  • Ceramic-on-XLPE showed 6.7% cumulative percent revision (CPR) at 20 years
  • Metal-on-XLPE was associated with a significantly higher recorded revision risk after 3+ years
  • Ceramic-on-ceramic (CoC) showed 8.8% CPR at 20 years

 

The “mixed ceramic” evolution

While the 20-year figures for CoC feature historical data, including for alumina ceramic, the current landscape has evolved:

  • In 2024, the registry reports that all CoC procedures used mixed ceramic (modern ceramic composite).
  • Heads ≥40mm in size were associated with lower recorded revision rates in this dataset with a 2.9% revision rate at 10 years.
  • Even at 15 years, 32mm mixed ceramic shows a strong 4.9% CPR.
  • In the contemporary mixed-ceramic group reported on in the registry, heads ≥40mm show a lower revision rate than 36-38mm heads (HR 1.24).
  • Revision for instability in the mixed-ceramic group reported on in the registry drops from 1.5% with ≤28 mm heads to just 0.1% for heads ≥40 mm.

 

Resurfacing snapshot: ReCerf®

Resurfacing remains a specialized niche (92.8% in males), but BIOLOX®𝘥𝘦𝘭𝘵𝘢 ceramic resurfacing technology as reported in the registry is indicating encouraging results:

  • 160 MatOrtho Ltd ReCerf® procedures were reportedly performed in 2024 (with no revisions recorded in the registry for that time window).
  • ReCerf® was reported with a 5-year CPR of 0.4%, which is considered low.

 

Clinical trends

Regardless of bearing surface, revision remains driven by four major factors infection (24.7%), fracture (22.4%), instability (21.3%), and loosening (19.5%).

The report puts the historical material alongside the contemporary. However, 20-year averages should not mask more recent performance. Registry stratification highlights modern mixed-ceramic CoC (especially with ≥40 mm heads), while CoXLPE remains common in current practice.

 

Please check for regulatory approval in your country.

 

This text was creared with the support of AI.

📖 Reference:

Lewis PL, Gill DR, McAuliffe MJ, Stoney JD, Vertullo CJ, Wall CJ, Corfield S, Esaian R, Moylan S, Du P, Holder C, Edwards S, Xu Q, Oakey H, Lorimer MF, Smith PN. Hip, Knee and Shoulder Arthroplasty: 2025 Annual Report, Australian Orthopaedic Association National Joint Replacement Registry, AOA: Adelaide, South Australia. Accessed October 16, 2025.

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