Choosing the Right Artificial Hip Joint: Ceramic vs. Polyethylene Options

Surgical Issues Related to Artificial Hip Joints

Hello, Doctor.
About 2 to 3 years ago, I was on long-term corticosteroid medication due to skin issues.
Recently, I experienced pain while walking and went to an orthopedic specialist for an X-ray, which revealed avascular necrosis in both hip joints.
The doctor assessed the right hip joint as stage 4 and the left hip joint as stage 3, recommending a hip replacement.
I would like to ask the following questions:
1.
I have researched various materials for artificial hip joints because I want to avoid the need for future surgeries to replace the artificial hip joint and extend its lifespan.
Therefore, I am considering opting for a self-funded fourth-generation ceramic hip joint.
However, I am unsure whether to choose a ceramic femoral head with a ceramic liner or a ceramic femoral head with a polyethylene (plastic) liner.
Although I have read that a ceramic femoral head with a ceramic liner has better wear resistance, there are concerns about potential breakage and noise.
How likely is this to occur? Given my current age (47 years), which combination would be better for me? If both combinations are subjected to the same wear conditions, will there be a significant difference in their lifespan?
2.
It is confirmed that the right hip joint needs to be replaced with an artificial hip joint.
However, for the left hip joint, which is assessed as stage 3, the doctor mentioned that if I do not want to have an artificial hip joint, I could undergo an autologous bone graft surgery, but the success rate of this surgery is only 60%.
In your professional opinion, do you think this surgery is worth pursuing, or should I proceed directly with the artificial hip joint replacement?
I would greatly appreciate your responses to these questions.
Thank you!

Mr. Wang, 40~49 year old female. Ask Date: 2018/01/17

Dr. Shi Guozheng reply Orthopedics

The two materials you mentioned have a similar lifespan, and both can be used.
Please refer to the attached reference for additional information.
Note that the success rate of bone grafting surgery is not very high, so it may be worth considering a direct total hip replacement surgery.

Reply Date: 2018/01/17

More Info

When considering the choice between ceramic and polyethylene artificial hip joints, it's essential to weigh the pros and cons of each material based on your specific circumstances, including your age, activity level, and the condition of your hip joints.

1. Material Options: Ceramic vs. Polyethylene:
- Ceramic-on-Ceramic: This combination is known for its excellent wear resistance and low friction, which can lead to a longer lifespan of the implant. However, there is a risk of ceramic components fracturing, although this is relatively rare with modern materials and techniques. The noise associated with ceramic joints, such as squeaking, can occur but is not universally experienced. Given your age (47 years), a ceramic-on-ceramic option may be beneficial as it could potentially last longer, especially if you are active.

- Ceramic-on-Polyethylene: This combination also offers good wear characteristics, but the polyethylene component may wear down over time, especially in younger, more active patients. However, modern polyethylene has improved significantly in terms of wear resistance. This option might be less prone to noise and fracture compared to ceramic-on-ceramic.

In terms of longevity, both combinations can provide a similar lifespan under optimal conditions, but ceramic-on-ceramic may have a slight edge in durability. The choice largely depends on your lifestyle and how much wear and tear you expect on the joint. If you are planning to engage in more vigorous activities, ceramic-on-ceramic might be the better choice.

2. Autologous Bone Grafting vs. Hip Replacement:
- The decision to undergo autologous bone grafting (which involves taking bone from another part of your body to repair the affected hip) versus proceeding directly to a hip replacement is complex. Given that the success rate of the grafting procedure is only about 60%, it may not be the most reliable option, especially considering the severity of your right hip joint (grade 4). If the left hip joint (grade 3) is not causing significant pain or functional impairment, you might consider monitoring it closely while opting for a hip replacement on the right side.

- Hip replacement surgery has a high success rate and can significantly improve your quality of life by alleviating pain and restoring mobility. If the left hip begins to cause issues in the future, you can always consider additional interventions at that time.

In conclusion, based on your age and the current condition of your hip joints, a ceramic-on-ceramic hip replacement for the right hip may be the most advantageous choice, providing durability and performance. As for the left hip, given the low success rate of the autologous bone grafting procedure, it may be prudent to proceed with the hip replacement on the right side and reassess the left hip's condition later. Always consult with your orthopedic surgeon to discuss your specific case, as they can provide tailored advice based on your overall health, activity level, and personal preferences.

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