Incidence of Ceramic Component Fractures in Total Hip Arthroplasty Using Contemporary Ceramic-on-Ceramic Bearings: A Retrospective Study Spanning Two Decades from Two Tertiary Referral Hospitals

Introduction: Ceramic-on-ceramic (CoC) bearings have been widely used in total hip arthroplasty (THA) due to their excellent wear properties. However, ceramic component fractures remain a concern. This study aimed to report the incidence of third- and fourth-generation ceramic component fracture and identify factors that might influence this complication.

Methods: A total of 9,280 hips that underwent THA with third- and fourth-generation CoC bearings at two tertiary institutions between 1997 and 2023 were retrospectively reviewed, and the incidence and associated factors of CoC-bearing fracture were determined. We performed a Kaplan-Meier survival analysis to assess implant survivorship. Logistic regression was applied to evaluate the influence of implant size and patient-specific factors on the risk of revision.

Results: Out of the 9,280 THA procedures, there were 33 (0.36%) revisions for CoC bearing fracture. Specifically, revisions for fracture were performed for zero out of 6,654 fourth-generation CoC heads, 26 (0.990%) of 2,626 third-generation CoC heads, two (0.030%) of 6,654 fourth-generation CoC liners, and five (0.190%) of 2,626 third-generation CoC liners. All ceramic head fractures occurred in a 28 mm head. Younger age was related to both ceramic head and liner fracture.

Conclusions: To our knowledge, this is the largest two-center retrospective study on CoC bearing fractures to date. The risk of revision for fracture of CoC bearings is low, as previously reported. Our data were comparable to recent evidence suggesting that the latest generation of ceramic components can significantly decrease the incidence of head fracture, but not liner fracture. Factors such as younger age and men may be associated with an increased risk of ceramic component fractures.