Objectives: Total hip arthroplasty (THA) with Ceramic-on-Ceramic (CoC) components achieved excellent outcomes. However, the long-term outcomes of anatomic and tapered stems are controversial in clinical practice, and the difference in the survival rates between the tapered stems and anatomical stems over the long term remains unknown.
Methods: A retrospective cohort study was performed to evaluate the 11-year follow-up outcomes of anatomic and tapered femoral stems. Between January 2009 and December 2011, a total of 1438 patients with COC were included in this study initially. Among these hips, 30 patients (30 hips) experienced death, and 254 hips (17.6%) were lost to follow-up. Finally, a total of 591 hips with Corail stem and a total of 334 hips with Ribbed stems were included in this study. The outcomes were evaluated by the modified Harris hip score (mHHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a questionnaire assessing articular noises.
Results: For the Corail stem, the survival rate with aseptic loosening or revision of any component for any reason as the endpoint was 99.1% at 11 years. The survival rate with reoperation for any reason as the endpoint was 98.8% at 11 years. For the Ribbed stem, the survival rate with aseptic loosening or revision of any component for any reason as the endpoint was 98.8% at 11 years. In patients with the Corail stem, the preoperative modified Harris hip score (mHHS) score, with a mean of 43.8 points, significantly improved to a mean of 93.5 points at the final follow-up assessment (p < 0.001). In patients with the ribbed stem, the preoperative mHHS score, with a mean of 40.9 points, significantly improved to a mean of 92.8 points at the final follow-up assessment (p < 0.001) during the follow-up period. The incidence of squeaking and squaking in the Corail group was significantly higher than that in the ribbed group (squeaking: 22.7% vs. 6.9%; squaking: 17.4% vs. 4.2%). The incidence of postoperative thigh pain was 4% in patients with the Corail stem, significantly lower than that in patients with the ribbed stem (17.4% vs. 4%; p < 0.001).
Conclusion: In conclusion, CoC THA with Corail and Ribbed stems exhibits excellent clinical outcomes at the long-term follow-up. However, the incidence of postoperative thigh pain in the Ribbed group is significantly higher than that in the Corail group, while the incidence of squeaking was lower.
| [1] |
I. D. Learmonth, C. Young, and C. Rorabeck, “The Operation of the Century: Total Hip Replacement,” Lancet (London, England) 370, no. 9597 (2007): 1508–1519.
|
| [2] |
O. Pakarinen, V. Ponkilainen, C. Varnum, et al., “Choice of Bearings Influences the Implant Survival of Total Hip Arthroplasty in Patients Who Have Osteoarthritis Aged 55 Years or Older: Results of 158,044 Patients From the Nordic Arthroplasty Register Association From 2005 to 2017,” Journal of Arthroplasty 40, no. 2 (2025): 437.
|
| [3] |
Y. K. Lee, B. H. Yoon, Y. S. Choi, W. L. Jo, Y. C. Ha, and K. H. Koo, “Metal on Metal or Ceramic on Ceramic for Cementless Total Hip Arthroplasty: A Meta-Analysis,” Journal of Arthroplasty 31, no. 11 (2016): 2637.
|
| [4] |
S. M. Kurtz, E. Lau, D. Baykal, and B. D. Springer, “Outcomes of Ceramic Bearings After Primary Total Hip Arthroplasty in the Medicare Population,” Journal of Arthroplasty 32, no. 3 (2017): 743–749.
|
| [5] |
G. Hallan, A. M. Fenstad, and O. Furnes, “What Is the Frequency of Fracture of Ceramic Components in THA? Results From the Norwegian Arthroplasty Register From 1997 to 2017,” Clinical Orthopaedics and Related Research 478, no. 6 (2020): 1254–1261.
|
| [6] |
K. J. Bozic, S. M. Kurtz, E. Lau, K. Ong, T. P. Vail, and D. J. Berry, “The Epidemiology of Revision Total Hip Arthroplasty in the United States,” Journal of Bone and Joint Surgery American Volume 91, no. 1 (2009): 128–133.
|
| [7] |
D. P. Howard, P. D. H. Wall, M. A. Fernandez, H. Parsons, and P. W. Howard, “Ceramic-On-Ceramic Bearing Fractures in Total Hip Arthroplasty: An Analysis of Data From the National Joint Registry,” Bone & Joint Journal 99 (2017): 1012–1019.
|
| [8] |
R. Rambani, D. M. Kepecs, T. J. Mäkinen, O. A. Safir, A. E. Gross, and P. R. Kuzyk, “Revision Total Hip Arthroplasty for Fractured Ceramic Bearings: A Review of Best Practices for Revision Cases,” Journal of Arthroplasty 32, no. 6 (2017): 1959–1964.
|
| [9] |
A. F. Heimann, G. N. Swartz, S. S. Bains, et al., “Long-Term Outcomes of Third-Generation Ceramic-On-Ceramic Bearings in Cementless Primary Total Hip Arthroplasty: A 25-Year Survival Analysis,” Journ al of Arthroplasty 40, no. 8 (2025): S243–S249.
|
| [10] |
H. S. Kim and J. J. Yoo, “Quarter Century Outcomes of Alumina Ceramic-On-Ceramic Total Hip Arthroplasty,” Journal of Arthroplasty 40, no. 4 (2025): 992–998.
|
| [11] |
W. G. Blakeney, Y. Beaulieu, B. Puliero, et al., “Excellent Results of Large-Diameter Ceramic-On-Ceramic Bearings in Total Hip Arthroplasty: Is Squeaking Related to Head Size,” Bone & Joint Journal 100 (2018): 1434–1441.
|
| [12] |
M. I. Goldhofer, S. Munir, Y. D. Levy, W. K. Walter, B. Zicat, and W. L. Walter, “Increase in Benign Squeaking Rate at Five-Year Follow-Up: Results of a Large Diameter Ceramic-On-Ceramic Bearing in Total Hip Arthroplasty,” Journal of Arthroplasty 33, no. 4 (2018): 1210–1214.
|
| [13] |
H. S. Khanuja, J. J. Vakil, M. S. Goddard, and M. A. Mont, “Cementless Femoral Fixation in Total Hip Arthroplasty,” Journal of Bone and Joint Surgery American Volume 93, no. 5 (2011): 500–509.
|
| [14] |
J. P. Vidalain, “Twenty-Year Results of the Cementless Corail Stem,” International Orthopaedics 35, no. 2 (2011): 189–194.
|
| [15] |
C. Luo, X. D. Wu, Y. Wan, et al., “Femoral Stress Changes After Total Hip Arthroplasty With the Ribbed Prosthesis: A Finite Element Analysis,” BioMed Research International 2020 (2020): 6783936.
|
| [16] |
K. Rilby, E. Nauclér, M. Mohaddes, and J. Kärrholm, “No Difference in Outcome or Migration but Greater Loss of Bone Mineral Density With the Collum Femoris Preserving Stem Compared With the Corail Stem: A Randomized Controlled Trial With Five-Year Follow-Up,” Bone & Joint Journal 104 (2022): 581–588.
|
| [17] |
N. Bellamy, W. W. Buchanan, C. H. Goldsmith, J. Campbell, and L. W. Stitt, “Validation Study of WOMAC: A Health Status Instrument for Measuring Clinically Important Patient Relevant Outcomes to Antirheumatic Drug Therapy in Patients With Osteoarthritis of the Hip or Knee,” Journal of Rheumatology 15, no. 12 (1988): 1833–1840.
|
| [18] |
Z. Li, E. L. Niu, J. Fu, et al., “A Nomogram That Characterizes a Patient's Odds of Developing Squeaking After Fourth-Generation Ceramic-On-Ceramic THA,” Clinical Orthopaedics and Related Research 481, no. 7 (2023): 1322–1336.
|
| [19] |
J. G. DeLee and J. Charnley, “Radiological Demarcation of Cemented Sockets in Total Hip Replacement,” Clinical Orthopaedics and Related Research 121 (1976): 20–32.
|
| [20] |
T. A. Gruen, G. M. McNeice, and H. C. Amstutz, ““Modes of Failure” of Cemented Stem-Type Femoral Components: a Radiographic Analysis of Loosening,” Clinical Orthopaedics and Related Research 141 (1979): 17–27.
|
| [21] |
R. D. Heekin, J. J. Callaghan, W. J. Hopkinson, C. G. Savory, and J. S. Xenos, “The Porous-Coated Anatomic Total Hip Prosthesis, Inserted Without Cement. Results After Five to Seven Years in a Prospective Study,” Journal of Bone and Joint Surgery American Volume 75, no. 1 (1993): 77–91.
|
| [22] |
Y. H. Kim, J. S. Kim, and S. H. Cho, “Primary Total Hip Arthroplasty With a Cementless Porous-Coated Anatomic Total Hip Prosthesis: 10- To 12-Year Results of Prospective and Consecutive Series,” Journal of Arthroplasty 14, no. 5 (1999): 538–548.
|
| [23] |
M. A. Mont, T. R. Yoon, K. A. Krackow, and D. S. Hungerford, “Clinical Experience With a Proximally Porous-Coated Second-Generation Cementless Total Hip Prosthesis: Minimum 5-Year Follow-Up,” Journal of Arthroplasty 14, no. 8 (1999): 930–939.
|
| [24] |
J. J. Callaghan, C. S. Fulghum, R. R. Glisson, and S. K. Stranne, “The Effect of Femoral Stem Geometry on Interface Motion in Uncemented Porous-Coated Total Hip Prostheses. Comparison of Straight-Stem and Curved-Stem Designs,” Journal of Bone and Joint Surgery American Volume 74, no. 6 (1992): 839–848.
|
| [25] |
C. W. Park, S. J. Jeong, K. Cho, S. Y. Kim, S. J. Lim, and Y. S. Park, “Bearing-Related Complications of Total Hip Arthroplasty Using Fourth-Generation Ceramic-On-Ceramic Articulations: Does Articular Noise Increase Over Time?,” Journal of Arthroplasty 39, no. 10 (2024): 2536.
|
| [26] |
M. Li, C. Xu, J. Xie, Y. Hu, and H. Liu, “Comparison of Collum Femoris-Preserving Stems and Ribbed Stems in Primary Total Hip Arthroplasty,” Journal of Orthopaedic Surgery and Research 13, no. 1 (2018): 271.
|
| [27] |
A. R. Knutsen, N. Lau, D. B. Longjohn, E. Ebramzadeh, and S. N. Sangiorgio, “Periprosthetic Femoral Bone Loss in Total Hip Arthroplasty: Systematic Analysis of the Effect of Stem Design,” Hip International: The Journal of Clinical and Experimental Research on Hip Pathology and Therapy 27, no. 1 (2017): 26–34.
|
| [28] |
Y. H. Kim, J. W. Park, and J. S. Kim, “Alumina Delta-On-Alumina Delta Bearing in Cementless Total Hip Arthroplasty in Patients Aged <50 Years,” Journal of Arthroplasty 31, no. 10 (2016): 2209–2214.
|
| [29] |
Y. S. Ko, S. Y. Kang, H. S. Kim, J. W. Park, Y. K. Lee, and J. J. Yoo, “Incidence of Ceramic Component Fractures in Total Hip Arthroplasty Using Contemporary Ceramic-On-Ceramic Bearings: A Retrospective Study Spanning Two Decades From Two Tertiary Referral Hospitals,” Journal of Arthroplasty 40, no. 4 (2025): 1055.
|
| [30] |
J. A. D'Antonio, W. N. Capello, and M. Naughton, “High Survivorship With a Titanium-Encased Alumina Ceramic Bearing for Total Hip Arthroplasty,” Clinical Orthopaedics and Related Research 472, no. 2 (2014): 611–616.
|
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2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
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