FDA Approval of Ceramic-Ceramic Hip Replacement

Ceramic-on-ceramic total hip replacements were FDA approved on February 3, 2002. On that date, two companies, Wright Medical and Stryker Corporation, received FDA approval for their ceramic-on-ceramic total hip replacements. Since then nearly all of the major joint replacement companies have been granted approval for their ceramic devices.

What is a ceramic-on-ceramic hip? Total hips replace the worn out ball and socket with artificial surfaces. The old standard was a polished metal ball and a polyethylene socket. The ceramic-on-ceramic hip uses an alumina (ceramic) ball against an alumina socket. We expect that these hips may last 20, 30, 40 years, or more, even in the young, active patient.

One of the main questions many of you may have is whether you should have a ceramic-on-ceramic hip vs. a ceramic-on-polyethylene or metal-on-polyethylene hip. As with anything in medicine, physicians need to weigh the risks against the benefits, with some consideration given to cost.

Although ceramic-on-ceramic has been around for many years in the US and Europe, some failures due to fracture of the ceramic material have been reported. When this happens, the broken shards of ceramic dispersed within the joint must be removed and a new ceramic replacement implanted. However, removal of every last particle of ceramic it is almost impossible, which may then cause the new joint to wear out prematurely.

Although ceramic fracture is certainly a worry, the true incidence of ceramic fracture, based on an evaluation of all the published literature addressing this complication, is probably no more than 1 in 5,000 to 1 in 10,000 cases. Thus, the risk of this catastrophic complication is quite low. To minimize the risk of ceramic fracture, the components must be implanted precisely to prevent impingement. For surgeons doing only the occasional total hip, this may be more difficult than for hip specialists doing several cases per week.

Polyethylene bearing surfaces have been around for 40 years and generally have a good track record in less active patients. An improved variety of polyethylene called "highly cross-linked polyethylene" has shown improved wear characteristics after relatively short-term follow-up (although nowhere near the improved results demonstrated in the lab). Polyethylene liners will last 20 years or more in most patients over the age of 60. Additionally, the polyethylene socket is much more forgiving than ceramic with respect to positioning of the implant, and better tolerates minor errors in implant position.

So, should you demand a ceramic-on-ceramic hip? If you are young (<60 years old) and active, a ceramic hip may allow your hip to last the rest of your life (potentially). What if you are 70 years old with some mild medical problems? The life expectancy of a 70 year old patient, according to the US Government actuarial table is approximately 16 years. Because polyethylene is more forgiving in many aspects and will last 20 years or longer in older, less active patients, a polyethylene socket may be in your best interest. Another option may be a highly-crosslinked polyethylene socket which will last longer than a standard polyethylene socket. Your surgeon should be able to recommend the best option for you.

Todd Swanson, MD

Dr Swanson has done approximately 750 ceramic-on-ceramic total hip replacements since 1999. The additional advantage Dr Swanson offers is the mini-incision surgical technique which gets patients on their feet and back to normal activities much more quickly.

Mini-incision General Information

To read the stories of Dr Swanson’s patients who received ceramic/ceramic hip replacements click here:
Ceramic-on-ceramic Hip Replacement Patient Stories

Disclaimer:The information provided here is intended to educate the reader about certain medical conditions and certain possible treatment. It is not a substitute for examination, diagnosis, and medical care provided by a licensed and qualified health professional. If you believe you, your child, or someone you know, suffer from the conditions described herein, please see your health care provider immediately. Do not attempt to treat yourself, your child or anyone else without proper medical supervision.

©2006 Todd Swanson, M.D.
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The minimally invasive total hip replacement was developed by Dr. Swanson after being introduced to the concept in early 1997. Dr. Swanson began using the technique in May of 1997 and has continued to make improvements that now allow reliable surgery and reproducibly good results in most patients. Standardization of the technique has allowed teaching to other surgeons. Numerous physicians and orthopedic companies have shown interest in promoting “minimally invasive surgery” for total hip replacements.

The minimally invasive technique utilizes a 3-4 inch incision, much smaller than the 8-10 inch approach historically used for hip replacement. Patients require less anesthesia and pain medication, and mobilize more quickly. This results in both quicker recovery for the patient and a lower incidence of complications.

Patients typically recover from minimally invasive surgery in about half the time it takes to recover from standard incision surgery (6 weeks vs. 12 weeks).

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