Alumina-on-alumina total hip prostheses in patients 40 years of age or younger

To avoid the consequences of polyethylene wear in a high-risk population, 1 28 alumina-on-alumina total hip arthroplasties have been done in 104 consec utive patients. The maximum age of patients was 40 years. The main preopera tive diagnoses were osteonecrosis and sequellae of congenital hip dislocati on (71% of the hips). The same titanium alloy cemented stem was implanted i n all of the hips. Four types of alumina acetabular component fixations wer e used: a cemented plain alumina socket (41 hips), a screw-in ring with an alumina insert (22 hips), a press-fit plain alumina socket (32 hips), and a press-fit titanium metal back with an alumina insert (33 hips), Eight pati ents (11 hips) died during the followup period. Sixteen revisions have been documented, 12 for acetabular aseptic loosening, three for bipolar looseni ng (two of which were septic), and one for unexplained pain. Eighty-eight h ips in 74 patients have been followed up radiologically for 2 to 22 years, Wear was unmeasurable. Four additional sockets showed definite migration. T he respective survival rates after 7 years were 94.1% for the cemented cup, 88.8% for the screw-in ring, 95.1% for cementless press-fit plain alumina socket and 94.3% for the metal-back press-fit component. The 10-year surviv al rate was 90.4% for the cemented socket and 88.8% for the screw-in ring. The 15-year survival rate was 78.9% for the cemented socket. Grafting was t he only prognostic factor, with a survival rate of 62.6% after 10 years for the hips with a bone graft and of 90.1% for hips without a graft. The alumina-on-alumina bearing surfaces seem to be a valuable alternative t o the standard metal-on-polyethylene system for young patients. However, an improvement in socket fixation Is required to lengthen the life span of th e prosthesis to match the life expectancy of this demanding population.