Ceramic-on-ceramic hips good option for juvenile arthritis

By Helen Albert, Senior medwireNews Reporter

medwireNews: Study results suggest that ceramic-on-ceramic artificial hip joints offer a better medium-term prognosis than metal- or ceramic-on-polyethylene joints for children with juvenile idiopathic arthritis (JIA).

Jas Daurka (University College London, UK) and colleagues found that none of the children who received ceramic-on-ceramic hips (23 hips in total) at a mean age of 14.4 years needed revision during a 10.5-year follow-up period.

By contrast, in the group of similarly aged children who received metal- or ceramic-on-polyethylene hips (29 hips in total), almost half (45%) required revision surgery during this time.

Total hip replacement has known benefits for children with severe JIA. However, less is known about the optimum bearing surface required for these patients to achieve a good long-term result.

For this study, Daurka and team reported the 10.5-year outcomes for 35 children and adolescents with JIA who received 52 uncemented total hip replacements.

Of the 13 hips that required revision during the follow-up period, 11 were metal-on-polyethylene and two were ceramic-on-polyethylene joints. Femoral and/or retroacetabular osteolysis was cited as the cause for revision in 10 cases, and acetabular and/or femoral component loosening in three cases.

Successful total hip replacement in children presents difficulties because their immature skeletons are still growing, among other factors, and good long-term outcomes can be hard to obtain.

The authors acknowledge that their study has limitations, such as the relatively small size of the cohort, and the fact that there was a significant difference in the mean length of follow up in the ceramic-on-ceramic group (8.5 years) compared with the ceramic- or metal-on-polyethylene group (12.7 years).

However, "the success seen in patients with a ceramic-on-ceramic articulation seems to indicate that this implant strategy has the potential to make a major difference to the long-term outcome in this difficult group of patients," suggest Daurka and co-workers in the British version of the Journal of Bone and Joint Surgery.

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