This week’s Orthopaedic Crossfire® debate was part of the 19th Annual Current Concepts in Joint Replacement® (CCJR®), Spring meeting, which took place in Las Vegas. This week’s topic is “Ceramic Heads Should Be Used in All Patients.” For is Donald S. Garbuz, M.D., F.R.C.S.(C) – University of British Columbia, Vancouver, British Columbia, Canada. Opposing is C. Anderson Engh, Jr., M.D. – Anderson Orthopaedic Research Institute, Alexandria, Virginia. Moderating is Daniel J. Berry, M.D. – Mayo Clinic, Rochester, Minnesota.
Dr. Garbuz: Full disclosure—I use ceramic heads in 100% of my patients. Most of you know Andy Engh, third generation orthopedic surgeon, won many awards for his research including the John Charnley award. And he has at least 80 peer-reviewed publications.
However, I find it surprising that a really smart guy like Andy is not using ceramic heads all the time. But Andy’s kind of an old-fashioned guy. It takes him a little while to take up new technology.
But I think even Andy will notice that there is a difference between ceramic heads and cobalt chrome. But you’ve got to look at wear and corrosion. And you’ve got to look beyond the first decade.
We’re talking about wear and subsequent osteolysis, aseptic loosening, and corrosion.
While there are not a lot of good robust comparative studies, there are a couple of cohort studies which basically show survival of 98% versus 96% in favor of ceramic-on-poly (Topolovac, et al., J Arthroplasty, 2014). Not a significant difference. Similar findings in this study (Meftah, et al., JBJS-Am, 2013), so a minor, if any, benefit for ceramic-on-poly.
From the UK registry, we’re getting out to 12 years and there is an advantage for ceramic-on-poly with a failure rate of 4.1 versus 5.4 for metal-on-poly. That is probably clinically and statistically significant.
When you look through all the literature—cohort studies, case series, registries—ceramic-on-poly is at least as good, maybe slightly better than metal-on-poly. Certainly the registries in the second decade are starting to diverge.
In 2012 the Rush Group published a paper (Cooper, et al., JBJS, 2012) showing corrosion can happen in metal-on-polyethylene. Ten cases I’ll acknowledge. Metal-on-poly pseudo-tumors were thought to be due to trunnion corrosion. This is fairly recent that patients present with pain, swelling, instability, and it’s not just large heads. These occur for 28, 32, and 36mm heads. All of us who do a high volume of cases have seen these.
