When we’re saying ceramic, of course, we’re talking about the Delta ceramic. When you look at relative cost…and it is institutional…so, rather than putting a price we can give a percentage—on average ceramic-on-ceramic is a significant price bump at about a 120% price premium.
Ceramic-on-ceramic also has unique complications. Squeaking. It is a serious complication that negatively affects patient outcomes. Let me take you through some papers on this.
The first one looked at 140 ceramic-on-ceramics; 30% of which—and this is current generation implants—30% were aware of the noise production, and they had lower satisfaction, lower Harris Hip Scores and lower SF-12 scores. (Gillespie, et al., J Orthop, 2016).
A 5-center study of young total hips, cobalt chrome reported increased instances of grinding, popping and clicking. Noise generation was associated with increased pain and stiffness (Nam, et al., Clin Orthop Relat Res, 2016).
Lastly, 336 ceramic-on-ceramic heads, 17% incidence of noise. This is not a rare, rare outcome at all (Salo, et al., JBJS, 2017). And again, lower outcome scores for these patients.
What about ceramic fractures?
A paper from the UK National Joint Registry, over 100,000 primary ceramic-on-ceramic total hips Howard, et al., Bone Joint J, 2017). The head fracture rate is 1 in 11,000, but the liner is 1 in 893. That’s a frequent complication.
They conclude in this article from last year from the Registry, “Previous studies have underestimated the risk of fracture…and Delta ceramic has greatly reduced the risk of head, but not liner fracture.” And that’s not even counting the insertional chipping that’s occurring that is dealt with in the operating room. And certain designs are hard to engage the taper.
So my friend, you got it half right. Ceramic-on-highly crosslinked polyethylene is a bearing for young patients. Adding a ceramic liner increases your failure rate; increases the cost, noise, other complications; decreases satisfaction and decreases outcome. That is what the data in 2018 is telling us.
I am 57 years old. I’ve been active in sports and outdoor activities all my life. I have had three orthopedic surgeon tell me I need a hip replacement because it is bone on bone. I have stopped running because of the pain. I still work out on an eliptical. I am considering as hip replacement using ceramic on ceramic. I live in southern Missouri about 4 hours South of St.Louis. Are there any surgeons relatively close to me that use the ceramic on ceramic material? I’ve seen on surgeon in New York, that uses ceramic on ceramic, but that’s a long way from home.
Thanks,
Darrell Brewer