New research appearing in the April 23, 2018 edition of HIP International asked the burning question, which is safer, 32-mm or 28-mm ceramic-on-ceramic (CoC) liners in total hip arthroplasty (THA)?
32-mm or 28-mm CoC Liner? Surprising Answer
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The answer came in the form of a paper which is titled, “32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study.”
Co-author and Nagoya University Graduate School of Medicine orthopedic surgeon Yoshitoshi Higuchi, M.D. told OTW, “We were seeing that 28-mm and 32-mm third generation ceramic liners (thickness was 4.1 and 4.3-mm) were thinner than the other ceramic liners (thickness was 5.2 to 7.0-mm).”
“Thus, my clinical questions were, ‘Were 28 and 32-mm ceramic liners easy to be broken?’ and ‘Which ceramic liners were easy to be broken?’”
To find the answer, the researchers looked at 107 joints (95 women and 6 men) which had been implanted with 28-mm CoC liners, and 60 joints (49 women and 7 men) which had received 32-mm CoC liners. The average age of the patients in the study was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively.
Dr. Higuchi told OTW, “The most important results was that there was no ceramic fracture in our study. So, I mentioned that the 28- and 32-mm ceramic on ceramic THAs are safe and are associated with good clinical outcomes.”
“I recommend to orthopedic surgeons that if they are avoiding using 28-mm or 32-mm ceramic liner to prevent ceramic fracture, please do not be afraid to use these thin ceramic liners because these ceramic liners are safe.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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