THA in patients younger than 30 years old presents challenges: the initial technical challenge relates to the initial disease that often causes deformities making reconstruction difficult, while the long-term challenge is wear and subsequent osteolysis and component loosening. Ceramic-on-ceramic prostheses may represent a valuable option to reduce wear. We retrospectively studied 101 patients (132 hips) with ceramic-on-ceramic prostheses implanted from 1977 to 2004. As a result of the long span of time, different implant designs and modes of fixation were used. The average age of the patients was 23.4+/-5 years (range, 13-30 years), and the main indication for THA was femoral head necrosis. The minimum followup was 1 year (mean, 6.9 years; range, 1-26.5 years). We documented 17 revisions (13%) for aseptic loosening. Twelve were for isolated acetabular loosening, two for isolated femoral loosening, and three for loosening of both components. Survivorship was 82.1% at 10 years and 72.4% at 15 years. Inferior survivorship was observed for THA performed after secondary arthritis related to slipped capital epiphysis or trauma. Limited osteolysis was observed in one hip. The main limiting factor in this series was the fixation of the acetabular component. However, improvements in the design and in the mode of fixation of this component should enhance long-term results.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.