Feature Articles

Ceramic Hip Replacement Gets Green Light from FDA;
700 Cases Already Performed Here 

For the past five years the Joint Replacement Center at Waterbury Hospital has served as one of a dozen centers nationwide testing a highly durable, long-wearing hip prosthesis made of ceramic.

 Under the direction of Kristaps Keggi, MD, Clinical Professor of Orthopaedic and Rehabilitation at Yale University, and Director of The Joint Replacement Center at Waterbury Hospital, approximately 700 Waterbury Hospital patients, in two clinical trials, have benefited from the ceramic-on-ceramic hip, as it's known, with excellent results.  Dr. Keggi has also used ceramic femoral heads with plastic sockets in over 2000 cases since 1984.

In February, the Food and Drug Administration (FDA) gave clearance for broader use of the ceramic hip. This means more individuals considering total hip replacement will benefit from the implant.

Below, Dr. Keggi answers questions about the ceramic hip, including who is a candidate for this type of implant.

What is ceramic-on-ceramic hip replacement?
Ceramic is a highly smooth and very durable material that is being used as an alternative to traditional metal-on-plastic or metal-on-metal hip replacement. With ceramic hip replacement, both the ball and socket are replaced with ceramic.  Dr. Keggi feels that in the long run the ceramic on ceramic devices are safer and are not associated with the potential for such systemic problems as kidney failure, blood and/or heart problems.

Why is ceramic so promising for hip replacement?
Ceramic glides easily as the joint is used. Because it moves easily, there is less friction, thereby generating fewer debris particles, which can cause inflammation, joint failure and loosening. With ceramic, there is virtually no 'debris disease.'

Does it last longer than other types of prostheses?
Yes. The current ceramic prosthesis has the potential to last indefinitely.

Who is a candidate for ceramics?
Ceramic is ideal for younger, active patients because of its ease in movement and overall durability. However, we have used ceramic-on-ceramic in over 700 patients since 1983, ranging in age from 12 to 75. Beginning in 1997, we started using an enhanced aluminum ceramic-on-ceramic implant made in Germany. So far approximately 500 patients have benefited from that device.

How many patients receive ceramic implants at Waterbury Hospital now?
Currently 15 percent of hip replacement patients at our Center are receiving ceramic-on-ceramic implants. Now that the FDA has approved the implant, I expect that number to grow quickly.

How do I know if I am a candidate?
Talk to your doctor. Research your options and ask for a personal referral to an orthopaedic center using the device. I encourage you to obtain more than one opinion. You may also contact our Center by calling 203-573-7635.

What is the complication rate with ceramic-on-ceramic?
In our series of close to 3000 ceramic type hips, we have had 3 ceramic fractures, all of them in very unusual situations. But, as is the case with all surgery, there is always the potential for complications, such as blood clots, infection and pneumonia. We have had a low rate of these general complications but anything can happen in spite of good surgery and excellent medical care.  These are the imperfections of life.

Will ceramic replace metal and plastic in the future?
Ceramic is the wave of the future for the young, the active, as well as heavy patients. The cost of these implants is, however, three times greater than the standard cemented/plastic devices. That will obviously be a major factor in determining their future use.