Clinical Study Clinical and Radiological Outcome of the Newest Generation of Ceramic-on-Ceramic Hip Arthroplasty in Young Patients Avishai Reuven, 1 Grigorios N. Manoudis, 1 Ahmed Aoude, 2 Olga L. Huk, 1 David Zukor, 1 and John Antoniou 1 1 Department of Orthopaedics, McGill University, Jewish General Hospital, 3755 Cote-St.-Catherine Road, Room E-003, Montreal, QC, Canada H3T 1E2 2 Medical School, University of Montreal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, Canada H3C 3J7 Correspondence should be addressed to Grigorios N. Manoudis; gregmanou@yahoo.com Received 11 September 2013; Accepted 29 December 2013; Published 12 February 2014 Academic Editor: Mel S. Lee Copyright © 2014 Avishai Reuven et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ceramic-on-ceramic articulations have become an attractive option for total hip arthroplasty in young patients. In this study, we retrospectively evaluated the short- to midterm clinical and radiographic results in 51 consecutive patients (61 hips) using the newest generation of ceramic implants. Results obtained in our study showed positive clinical and radiological outcomes. Both HHS and UCLA activity scores doubled ater surgery and tended to increase over time. here was one infection requiring a two-stage revision and a case of squeaking that began 2 years postoperatively ater a mechanical fall. he overall survival rate of the implants was 98.4% at six years with revision for any reason as the end point. Based on these results, fourth generation ceramics ofer a viable option for young and active patients. 1. Introduction One of the most challenging problems that orthopaedic surgeons are facing today is the increasing number of young and active patients requiring long lasting and reliable primary total hip arthroplasty (THA) [1]. It is well known that bearing surface wear and particle-driven osteolysis remain the major factors threatening the longevity and limiting the perfor- mance of the implant [2, 3]. Ceramic-on-ceramic (CC) hip articulations made form alumina have become an attractive option for young and active patients who require THA. his is partially due to the excellent wear characteristics and outstanding tribological properties of alumina over metal- on-polyethylene (MP) bearings [4, 5]. In addition, the inert nature of alumina gives the CC surfaces a great advantage over metal-on-metal (MM) surfaces [6]. Alumina CC bearings have a long history of use [7]. Initial attempts of ceramic-on-ceramic THA had high failure rates that were mainly related to bad design and laws in the material [8, 9]. Further advancements in alumina manufacturing technology such as hot isostatic pressing led to the fabrication of a highly puriied alumina (BIOLOX forte; CeramTec AG, Plochingen, Germany) with increased mate- rial density, decreased grain structure, and less impurities [10, 11]. All these material improvements yielded a noticeable decrease in the rate of implant components fracture and chipping [12, 13]. Despite the advancements made in the quality of alumina ceramic, substantial concerns remain regarding CC bearings including stripe wear, limited sizing option, squeaking, and ceramic implant fracture. Limitations of pure alumina characteristics required the development of an advanced ceramic material. Ceramic composites were the next step in the develop- ment of CC bearings. he newest generation of BIOLOX delta ceramic bearings was introduced in 2000 by CeramTec AG (Plochingen, Germany). BIOLOX delta is an alumina- matrix composite (AMC) consisting of 81.6% aluminium oxide, 17% yttria-stabilized tetragonal zirconia particles, and traces (1.4%) of chromium dioxide and strontium crystals engineered to increase material density and reduce grain size (less than 0.8 m compared with the grain size of alumina 1– 5 m) [14–16]. With these improvements, the risk for crack Hindawi Publishing Corporation Advances in Orthopedic Surgery Volume 2014, Article ID 863748, 6 pages http://dx.doi.org/10.1155/2014/863748