Metal-on-metal (MoM) hip resurfacing (HR) has shown excellent results and survivorship, particularly in male patients or those meeting specific selection criteria. However, revision risks remain high for female patients and those with smaller femoral head sizes (≤ 48 mm), casting doubt on the suitability of MoM HR for these groups. Consequently, ceramic-on-ceramic (CoC) HR has been introduced as a potential alternative. This study aims to evaluate the five-year survivorship of CoC HR, focusing on the impact of gender and implant size on revision rates. A retrospective, multi-center analysis was conducted, encompassing 604 consecutive patients (330 males, 264 females) with a mean age of 50 years (range 20–80 years) who underwent CoC HR between September 2018 and June 2024. No patients were lost to follow-up, and all revisions were documented. Survivorship at five years was assessed through Kaplan-Meier analysis, while a Cox proportional hazards model evaluated the influence of gender and femoral head size on revision risk. The mean follow-up was 3.6 years, ranging from 2.4 to 5.7 years. Overall five-year survivorship for CoC HR was 98.2% (95% CI: 96.7%–99.0%). When analyzed by gender, survivorship was 98.1% for males (95% CI: 95.7%–99.1%) and 98.4% for females (95% CI: 95.7%–99.4%). Analysis by femoral head size revealed similar outcomes, with 98.4% survivorship for head sizes ≤ 48 mm (95% CI: 95.9%–99.4%) and 98.0% for head sizes ≥ 48 mm (95% CI: 95.6%–99.1%). Multivariate analysis showed no statistically significant differences in revision risk associated with gender or femoral head size. The odds ratio (OR) for males was 1.2 (95% CI: 0.21–6.9; p = 0.84), and an increase in head size by 1 mm was linked to an OR of 1.0 (95% CI: 0.81–1.23; p = 0.99), indicating minimal influence from these factors. Ten revisions were observed: three due to periprosthetic fracture, two due to aseptic loosening, four from persistent pain, and one instance of femoral head collapse secondary to avascular necrosis. Five-year outcomes for CoC HR indicate excellent survivorship, with no significant variation based on gender or implant size. These findings are favorable compared to MoM HR, where female patients and smaller component sizes have been associated with lower survivorship. CoC HR may offer a durable alternative to MoM HR with a reduced risk of adverse reactions, though longer follow-up is essential to confirm durability and clinical efficacy.
Koh et al. (Wed,) studied this question.