'4th Generation Ceramic Used in Artificial Hip Arthroplasty', First Proven Safety and Effectiveness in Young Adults

Bundang Seoul National University Hospital, Over 10 Years of Observational Study
World's First to Demonstrate Effectiveness
7.6% Reoperation Rate
No Cases of Ceramic Fracture

Domestic researchers have identified the long-term safety and effectiveness of artificial hip replacement surgery using '4th generation' ceramic joint surfaces. Notably, they conducted the world's first study observing patients under 30 years old for over 10 years, thereby proving its safety.

Professor Lee Young-kyun (left) and Professor Park Jung-wi, Department of Orthopedic Surgery, Bundang Seoul National University Hospital. [Photo by Bundang Seoul National University Hospital]

Artificial hip replacement surgery involves removing the damaged joint and replacing it with an artificial joint to treat conditions such as avascular necrosis of the femoral head, where the hip bone dies due to lack of blood supply. Avascular necrosis of the femoral head mainly occurs in patients in their 40s and 50s but can occasionally appear in younger patients. Until now, elderly patients could be treated with total hip replacement using 3rd generation ceramic joint surfaces. However, due to higher activity levels and longer life expectancy, younger patients faced risks of wear and breakage, limiting the active use of this surgery. It was only after the development of 4th generation ceramic joint surfaces that the surgery began to be performed more actively.

The orthopedic surgery team led by Professors Lee Young-gyun and Park Jeong-wi at Bundang Seoul National University Hospital conducted a prospective study on 71 patients aged 30 or younger who underwent artificial hip replacement using 4th generation ceramic between 2008 and 2012, with follow-up for over 10 years. To investigate ceramic breakage, wear, and other complications, general radiography and computed tomography (CT) scans were performed at ▲6 weeks ▲6 months ▲1 year post-surgery and then annually. Questionnaires and face-to-face interviews were also conducted to assess noise and discomfort.

As a result, the rate of revision surgery over 13 years was 7.6%, with no cases of ceramic breakage. Additionally, the Harris Hip Score, which quantifies hip function and indicates biocompatibility, improved from 59.40 before surgery to 96.51 at the final follow-up. Particularly, the Forgotten Joint Score, a measure of patients’ ability to forget they have an artificial joint and thus experience no discomfort in daily life, was 73.9, indicating that most patients comfortably resumed daily activities. Radiological examinations showed no issues. Noise at the surgical site occurred only intermittently and was not accompanied by pain, thus not affecting daily life.

Professor Park Jeong-wi stated, "This study is the world’s first to demonstrate the safety and effectiveness of artificial hip replacement using 4th generation ceramic in young patients," adding, "Patients at risk of hip diseases such as avascular necrosis of the femoral head at a young age should consider artificial hip replacement using 4th generation ceramic." Professor Lee Young-gyun added, "Since patients under 30 are highly active and have a long life expectancy, regaining a comfortable daily life is paramount. If 4th generation ceramic artificial hip replacement is performed with precise surgical techniques, it offers not only long-term survival but also excellent biocompatibility." This study was published in the world-renowned orthopedic journal, The Journal of Bone and Joint Surgery.

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