Dear Readers,

I am happy to share with you this new edition of the CeraNews supplement dedicated to arthroprosthetic registries, in which, as in previous editions, we gather trends on the use of articular bearings from the “real world” of total hip arthroplasty.

Not surprisingly, we focus on the use and performance of ceramic materials for hip replacements as documented by seven major national arthroplasty registries: 
NJR, AOA NJRR, EPRD, AJRR, NZJR, SAR, and LROI.

Readers' feedback has been extremely generous since we started, so we are thrilled to hear your feedback on this CeraNews registry supplement issue and hope that our readers will enjoy this 2024 edition as well. The previous editions have met with considerable success, and so we try each year to improve and offer new data as soon as the annual registry reports are publicly available. The lack of harmonization among registries still makes this task difficult, but we still strive year by year to improve it. I sincerely hope you enjoy it.

Fixation

Like every year, interesting new trends are caught or trends that were weak and are strengthening to significance.Indeed, the data from 2023 reveals an interesting shift towards hybrid fixation techniques across most registries. Notably, the NJR and NZJR now report hybrid fixation as the top choice for hip replacements, indicating a clear shift away from uncemented fixation. For the first time, hybrid fixation has overtaken uncemented methods in the NZJR, covering 45% of procedures. This trend signifies a growing preference for combining the best of both worlds to improve surgical outcomes.

Ceramic Femoral Heads: The New Standard

Ceramic femoral heads confirm their popularity, becoming the preferred choice in many regions. According to the 2023 data, 54.2% of all total hip replacements (THRs) in the NJR, 90.4% in the EPRD, 27% in the SAR, and 75.9% in the LROI utilized ceramic femoral heads. The AJRR reports a cumulative usage rate of 81.4% from 2012 to 2022, reflecting a 3.4% increase from 2021. This growing adoption underscores the clinical trust in ceramic materials, known for their durability and superior performance.

Ceramic-on-Polyethylene (CoP) bearings has emerged as the most favored bearing option in the NJR, EPRD, AJRR, NZJR, and LROI. The shift towards CoP bearings is primarily at the expense of Metal-on-Polyethylene (MoP) and Ceramic-on-Ceramic (CoC) bearings despite excellent results in the registries for ceramic monobloc constructs. The preference for CoP highlights its excellent clinical outcomes it delivers.

Delta Ceramic-on-Ceramic Resurfacing

The AOA NJRR documented 346 MatOrtho ReCerf® hip resurfacing, while the NJR reported 249 Embody Ltd. H1® hip resurfacing procedures. Early results are promising, with significantly lower revision rates for BIOLOX®delta Ceramic-on-Ceramic (CoC) resurfacing compared to Metal-on-Metal (MoM) resurfacing, particularly in the short term. These findings are a first indication that modern ceramics could redefine the standards of hip resurfacing.

Expanding Use of Dual Mobility Bearings

Dual mobility bearings are gaining more users in both primary and revision hip arthroplasty procedures. The NJR is currently the only registry reporting the use of ceramic heads within dual mobility constructs, with 41% of these implants featuring ceramic heads in primary procedures.

While we keep observing these advancements, it's crucial to address ongoing challenges. Infection remains the leading cause of revision surgeries in both Australia (23.3%) and the United States (22.5%), highlighting the need for enhanced infection control protocols. Aseptic loosening, dislocation, and periprosthetic fractures continue to be significant concerns, requiring continuous innovation and vigilance.

Today’s popularity of ceramic materials in hip arthroplasty, introduced in the 1970s by pioneers such as Prof. Boutin and Prof. Mittelmeier, is the evidence of the power of innovation and evidence-based practice. As we now anticipate the publication of the 2024 hip registries starting after this summer, we at CeramTec remain committed to advancing orthopaedic care for the benefit of healthcare systems and patient outcomes.

Happy Reading