Wear debris from metal-on-polyethylene articulation in conventional total hip arthroplasty (THA) may limit THA longevity. Bearing surfaces made of modern ceramic material, with high wear resistance and low fracture risk, have the potential to extend the longevity of THA and make the procedure more suitable for young, active patients. Concerns regarding a ceramic-on-ceramic bearing surface have included potential for a higher incidence of dislocation caused by limited modular neck length and liner options. This prospective study assessed the early dislocation incidence for a ceramic-on-ceramic THA system. Out of the 336 consecutive ceramic-on-ceramic THA performed at our institution over an 8-year (1997–2005) period, 2 (0.6%) sustained dislocation during, and none after, the first postoperative year. Both dislocations were treated with closed reduction. No component fracture or revision for any reason has occurred in this series.

Modular acetabular systems have several advantages; however, increased polyethylene wear has been recognized as a disadvantage. In our study, an acetabular shell design with a highly polished inner surface, a locking mechanism that minimizes micromotion, and a high polyethylene liner to shell conformity was evaluated. A prospective cohort of 50 consecutive hips was followed up for a mean of 3.6 years (range, 2–7 years). One patient required an early revision for recurrent instability. Mean linear head penetration rates were 0.242 mm/year (range, 0.048–0.655 mm/year). The true linear wear rate was calculated after subtracting the linear wear in the first follow-up year from the total wear at the end of the follow-up. The true linear wear rate was 0.173 mm/year (range, 0.03–0.423 mm/year). A positive correlation was found between wear rate and male gender. The low head penetration rates suggest that a polished liner with an improved locking mechanism and increased liner conformity can reduce polyethylene wear.

The effect of closed-suction drainage with red-cell reinfusion on patients receiving low molecular weight heparin (LMWH) prophylaxis after total knee arthroplasty (TKA) has not been previously studied. Therefore, our goals were to determine the effect of reinfusion drains and LMWH on allogeneic transfusions and wound complications after TKA by comparing patients treated with and without drains. Overall, transfusion rates were lower in the drain group (40% vs 15%, P=.04). Patients with reinfusion drains had a significantly higher rate of allogeneic transfusion (15.8%) than those predonating autologous blood and no drain (5.4%, P=.0003). The drain group had lower rates of wound complications (P=not significant). We were unable to demonstrate the efficacy of red-cell reinfusion as a substitute for autologous donation in TKA.