ORIGINAL PAPER Mid-term result of ceramic bearings in total hip arthroplasty Ismail Remzi Tozun & Vahit Emre Ozden & Goksel Dikmen & Burak Beksac Received: 13 May 2014 /Accepted: 14 May 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose The purpose of this study was to evaluate our clinical experience with ceramic-on-ceramic cementless total hip arthroplasty (THA) and complications after an average follow-up of more than eight years. Methods From January 2001 to December 2008, 540 THA with ceramic-on-ceramic bearings were performed in 448 patients (92 bilateral, 54 of which were operated simulta- neously) with a mean age 49.9 years (range 18–84) by a senior surgeon. Pre-operative aetiological reasons were developmen- tal dysplasia of the hip (DDH) in 205 hips, degenerative arthritis in 157 hips, avascular necrosis in 51 hips, rheumatoid diseases in 40 hips, posttraumatic arthritis in 40 hips, other reasons in 25 hips and revision surgery in 22 hips. Patients were evaluated with Harris hip score (HSS), and radiological findings of acetabular and femoral component loosening or osteolysis with ceramic bearing related complications like squeaking, liner and head fractures were recorded. Result The average duration of follow-up time was 8.2 years (range, five to 13.2). The main Harris hip score increased from 42.4 points preoperatively to 94.9 points at the time of last follow-up. We had one fracture of the ceramic head, 11 clicking and four squeaking; one of them was revised because of terrible squeaking due to acetabular liner fracture, the other three were seldom audible from the outside and followed conservatively. We did not observed loosening or osteolysis due to ceramic bearings at the time of the final follow-up. Conclusion Our study has demonstrated that ceramic-on- ceramic bearings can be used safely in different etiological problems. Incidences of noisy hips are becoming less frequent. Keywords Ceramic-on-ceramic . Total hip arthroplasty . Squeaking . Ceramic liner fracture . Clicking Introduction The popularity of ceramic-on-ceramic surfaces in total hip arthroplasty (THA) has been increasing in the last decade because of improved tribology and biocompatibility with the promise of increased longevity [1]. New ceramic surfaces have higher mechanical properties than conventional polyeth- ylene or metal surface bearings, very low friction coefficient with superior lubrication characteristics and wettability that results in less wear and bioactive particular debris and subse- quent osteolysis [1–3]. The use of alumina ceramics in total hip arthroplasty began in Europe and Professor Pierre Boutin pioneered the use of ceramics in France in 1970 [4]. In Germany, Professor Mittelmeier was the first surgeon who used alumina–alumina (Al–Al) in 1974. After Mittelmeier’ s design, ceramic bearings had been used worldwide [5]. First generation alumina–ceram- ic bearings showed some disappointments like acetabular com- ponent loosening due to poor component fixation and ceramic fracture during activities of daily living. First and second generation ceramics also had the same problems but after I. R. Tozun : B. Beksac Department of Orthopedics and Traumatology, Acibadem Medical Faculty, Acibadem Maslak Hospital, Maslak Istanbul, Turkey 34457 I. R. Tozun e-mail: rtozun@gmail.com B. Beksac e-mail: bbeksac@gmail.com V. E. Ozden : G. Dikmen (*) Department of Orthopedics and Traumatology, Acibadem Maslak Hospital, Maslak Istanbul, Turkey 34457 e-mail: gdkmen@yahoo.com G. Dikmen e-mail: drgokseldikmen@gmail.com V. E. Ozden e-mail: vahitemre@gmail.com International Orthopaedics (SICOT) DOI 10.1007/s00264-014-2387-x