Alumina-on-alumina bearings in total hip replacement have been used for 30
years. Excellent tribologic properties and extra low debris generation coul
d, in theory, provide an answer to osteolysis. A review of the authors' exp
erience with alumina-on-alumina bearings showed that, except in a few beari
ngs that had been loose for a long time, osteolysis was not a problem. Alth
ough the cemented titanium stem and the alumina-on-alumina couple were not
a problem, fixation of the socket had to be im proved. To improve the socke
t fixation system and to avoid the use of a cemented titanium stem that may
have created problems in the long-term, a new design was introduced in 199
7. The current authors present the preliminary results of the first 96 hips
with cementless fully-coated hydroxyapatite titanium alloy stems and socke
ts, 32-mm alumina femoral head, and alumina liner, both held with a Morse t
aper. Ninety-six consecutive hips in 89 patients (57 males, 32 females) wit
h a median age of 46 years (range, 14-72 years) were analyzed. One socket w
as revised at 4 months because of poor primary stability in a patient with
a severe acetabular fracture. One patient experienced a traumatic fracture
of the implanted femur 3 weeks after surgery. The mean followup was 16 mont
hs (range, 4-38 months). One patient died from rupture of an aneurysm. Nine
ty-three hips in 86 patients were assessed regarding the clinical and radio
logic ratings. Two patients (two hips) were interviewed by telephone. The M
erle d'Aubigne rating system was 18 in 65 hips (59 patients), 17 in 25 hips
(25 patients), and 16 in three hips (three patients) mainly related to a p
revious disability including limp, sciatic palsy, or stiffness. Examination
of 93 available radiographs revealed no ostelolysis, no radiolucent lines
at the last examination, and no subsidence. The level of excellent results,
even in this young population, and lack of osteolysis and wear are encoura
ging, even if the followup is too short to allow any conclusions to be made
.