Issue # 22022
Clear Trends Are Favoring Ceramics
Dr. Alessandro Alan Porporati
Director Medical and
CeramTec GmbH, Germany
The latest figures speak for themselves. According to the six most important national registries, the use of ceramic components in arthroplasty is on the rise. In 2020, 48.8% of all primary total hip replacements registered in the NJR*, around 60% in the AOA NJRR*, 89.3% in the EPRD*, 61% in the NZJR*, around 26% in the SAR*, and 71.1% in the AJRR* were performed with ceramic femoral heads. This accounts for an increase of more than 3.8% in the NJR, about 2% in the AOA NJRR, 0.4% in the EPRD and 2.1% for the AJRR compared to the previous year. The use of ceramic-on-polyethylene (CoP) bearings has generally increased in 2020. According to the NJR, hybrid CoP figures have grown in particular, making this the most often utilized construct in 2020. Correspondingly, the use of metal femoral heads has again declined in 2020.
Recurrent dislocation, infection, periprosthetic fracture and aseptic loosening are still the main complications with these products leading to revision. On the other hand, according to the NJR, revision rates for CoP bearings remain consistently low or equivalent to other bearings across all fixation types for up to ten years. The NJR shows that good results were obtained with CoC and CoP bearings in young patients. The AOA NJRR also shows that CoXLPE has a lower rate of revision compared to MoXLPE after the first two weeks. According to the EPRD, CoC shows the lowest short- and mid-term failure rates among all bearing surfaces. Obviously, the good clinical results support the observed trends.
We can say that statistics show more than promising figures for ceramic bearings. New applications such as dual mobility can benefit from the excellent biocompatibility and extraordinary wear resistance of advanced ceramics. The number of dual mobility bearings implanted has steadily increased over the years. According to the AJRR, the use of dual mobility in primary and revision hip replacements has continued to increase and in 2020 accounted for 10.5 percent of all bearings used in elective primary surgeries and for more than 25 percent of all revision procedures. The NJR is currently the only registry reporting the use of ceramic heads with dual mobility constructs, and nearly one-third of the total dual mobilities implanted in a primary procedure in 2020 had a ceramic head. The Australian registry reports a lower revision rate for dislocation with this solution, in comparison with all other acetabular prostheses.
AJRR: The American Joint Replacement Registry
NJR: The National Joint Registry, which covers England, Wales, Northern Ireland, the Isle of Man and the States of Guernsey
AOA NJRR: The Australian Orthopaedic Association National Joint Replacement Registry
EPRD: Endoprothesenregister Deutschland
NZJR: The New Zealand Joint Registry
SAR: The Swedish Arthroplasty Register