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CeramTec is committed to selecting and bringing to interested parties relevant articles on bioceramics related topics. The presented authors’ views and opinions are solely those of the authors of these publications. It is the focus and intent of CeraNews that CeramTec presents and comments on the authors’ views and opinions in a specific context. Such comments and editorials therefore solely express CeramTec’s views and opinions and not necessarily those of the quoted authors.

Issue # 12023

Insights from Hip Registries: the Continued Rise of Ceramic in Clinical Use

Dr. Alessandro Alan Porporati

Director Medical and Scientific Affairs
CeramTec GmbH, Germany

In medicine, staying informed about trends and advancements is not just an obligation, but a necessity to ensure the highest standard of patient care. In this new edition of CeraNews, we explore insights from the seven most utilized registries worldwide.


This comprehensive review offers a international view of current usage and developments in hip replacement with a special focus on bearings, highlighting fixation techniques, material used and new trends. This analysis aims to reflect the clinical outcomes and the clinical practice of hospitals with one unique goal: understanding how the choice of bearings may impact patient outcomes.


While RCTs are invaluable in clinical research, it is undeniable that registries have become an established source of evidence for HCPs. Real-world data compiled by registries year after year provide comprehensive insights into implant performance and patient outcomes.


Comparing the multitude and heterogeneity of registry data is complex. Nevertheless, the real-world data speaks for itself. The registries annual reports covering arthroplasty year 2021 still reflect the effects of the pandemic. Aside from these effects, for the first time the usage of ceramic femoral heads exceeded that of metal femoral heads in the England, Wales, Northern Ireland, the Isle of Man and Guernsey, and cumulative data from the USA reported usage at 76.3%, a rise of 3% from 2020. Correspondingly the use of metal femoral heads has once again declined. The seven selected registries are defined as the most relevant due to the number of procedures recorded annually and/or the quality of the data collected and analysed.


Registry dataset analyses summarized in the annual reports reflect year on year the increasingly better outcomes of ceramic bearings compared to metal bearings. Revision rates have remained consistently low, or equivalent to those of other bearings with all fixation options up to fifteen years. Good results were also noted in England, Wales, Northern Ireland, the Isle of Man and Guernsey with Ceramic-on-Ceramic and Ceramic-on-Poly bearings in younger patients. Regardless of the fixation method, the New Zealand Joint Registry highlights lower revision rates for Ceramic-on-Ceramic than both Ceramic-on-Poly and Metal-on-Poly.


Clinical outcomes for Ceramic-on-Ceramic resurfacing are increasingly available due to the growing number of procedures. 298 Ceramic-on-Ceramic resurfacing procedures alone were recorded in Australia. The significantly better outcomes for Ceramic-on-Ceramic compared to Metal-on-Metal in the short-term are positive signs for future success. A cumulative revision rate of 0.3 (0.0, 2.5) is reported at one year, which is significantly lower than that for Metal-on-Metal resurfacing combinations.


While the use of dual mobility bearings continues to steadily increase internationally, currently the NJR is the only registry reporting the use of ceramic heads in dual mobility constructs. In 2021 almost one-third of the total dual mobility constructs implanted had a ceramic femoral head.


With excellent survival rates, hip replacement remains without any doubt the “operation of the century”*. Still some challenges remain, though. Let’s continue to learn, to advance together and to offer patients the best possible outcomes. Arthroplasty registries have proven to be effective in advancing these objectives for patient safety. A harmonization of registries could possibly expand the pool of real-data, enabling a comprehensive analysis of implants globally.


Happy reading!


Dr. Alessandro Alan Porporati



* Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508-1519. doi:10.1016/ S0140-6736(07)60457-7.

Outcomes Research

About Bearings and Hip Procedures: What Registries Say

Insights from the annual registry reports 2022 highlight persistent global trends s in hip replacement strategies, with a clear move towards uncemented and, notably, hybrid fixation methods. Larger head sizes and dual mobility solutions are increasingly favoured for addressing instability issues and are gaining traction in the field. A particularly distinct trend, which has been strengthening over several years, is the gradual preference for ceramic components over metal femoral heads.

Outcomes Research

Revisions and Failure Modes: International Rankings

Despite the ongoing harmonization in terminology between registries, the predominant reasons for hip revision exhibit consistency across the national registries. Only the order of prevalence differs among countries. Common causes such as loosening, infection, dislocation, and periprosthetic fractures consistently appear at the forefront. It is notable that the adoption of ceramic components in hip replacements is associated with less complications (like fretting corrosion) and reduced revision rates as confirmed by registry analysis.

Outcomes Research

PROMS: Evaluating Health Gains and Patient Satisfaction

Concurrently, there is an increasing emphasis on Patient-Reported Outcome Measures (PROMs) to evaluate health gains from the patient’s perspective post-surgery. This helps to contextualize revision rates and patient satisfaction. Worth knowing: In 2022, both the NJR and the AOA NJRR started to separately report PROMs, with a trend towards implant specific brand assessments.

Download the full issue

Download the CeraNews issue 1/2023 as a PDF including all three the articles:
"About Bearings and Hip Procedures: What Registries Say"
"Revisions and Failure Modes: International Rankings"
"PROMS: Evaluating Health Gains and Patient Satisfaction"

Issue #1 2023: Insights from Hip Registries: the Continued Rise of Ceramic in Clinical Use
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