CORR Insights®: Primary Ceramic-on-ceramic Total Hip Arthroplasty Using a 32-mm Ceramic Head with a Titanium-alloy Sleeve

C eramic-on-ceramic bearings have become a popular alternative to conventional polyethylene in THA. The major advantages of ceramic bearings for THA include their scratch resistance, low coefficient of friction, less-reactive particulate debris, and superior wear resistance. Dating back to the 1970s, ceramic bearing failures were primarily related to aseptic implant loosening and catastrophic ceramic fractures [1]. In the 1990s, a new generation of alumina ceramic bearings became available with higher quality and greater burst strength [3]. They were also mated with implants that had excellent fixation records and high taper tolerances. Despite these advances, ceramic fracture, neck socket impingement, and squeaking remain a current concern. Fracture risk is increased with smaller diameter femoral heads, malpositioned sockets, and the presence of trunnion debris and/or damage. Impingement and squeaking are typically related to implant position, design, and material properties. A more recent concern is the use of larger diameter femoral heads on smaller trunnions. Larger-diameter femoral heads carry a greater risk of fretting corrosion and adverse local tissue responses (ALTRs). Retrievals and in vitro studies [4] have found less fretting corrosion at the head neck junction with ceramic femoral heads compared to metal heads. The addition of a Ti sleeve within the ceramic head decreases the potential risks of fracture from trunnion debris and or damage. However, the metal sleeve raises some concern regarding the potential of fretting corrosion and ALTRs. In the current study, Lim and colleagues reviewed alumina ceramic bearings utilizing a titanium alloy sleeve within the modular ceramic femoral head with a minimum 5-year followup. Currently, clinical studies utilizing alumina ceramic bearings without Ti sleeves have minimum 10-year followup [2, 5]. The principal issues to compare are survivorship revision for any reason, ceramic fracture, and incidence of osteolysis. The authors reported a 97% survivorship for revision for any reason. This is similar to survivorships ranging from 95% to 99% found by others [2, 5]. This CORR Insights is a commentary on the article ‘‘Primary Ceramic-on-Ceramic Total Hip Arthroplasty Using a 32-mm Ceramic Head with a Titanium-alloy Sleeve’’ by Lim and colleagues available at: DOI:10.1007/ s11999-015-4374-y. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI:10.1007/s11999-0154374-y. J. A. D’Antonio MD (&) Greater Pittsburgh Orthopaedic Associates, 725 Cherrington Parkway, Suite 200, Moon Township, PA 15108, USA e-mail: dantonioja@me.com CORR Insights Published online: 20 June 2015 The Association of Bone and Joint Surgeons1 2015