Ceramic Bearings in Total Hip Arthroplasty: Early Clinical Results and Review of Long Term Experiences

Abstract

Periprosthetic osteolysis and aseptic loosening are serious problems affecting the outcome of total joint replacement. Polyethylene particulate debris generated from metal-on-polyethylene bearing surfaces and the resulting biological response to this debris are thought to be largely responsible. Accumulation of particulate debris can result in an aggregation of macrophages that attempt to phagocytize it. The ensuing chronic inflammatory response is characterized by the release of lytic enzymes, proinflammatory cytokines, and bone-resorbing mediators, resulting in osteolysis that can cause aseptic loosening and fixation failure. As a result, there has been a renewal of interest in ceramic bearing surfaces for total hip arthroplasty. Ceramic-on-ceramic bearings for total hip arthroplasty have demonstrated lower friction and wear characteristics than metal-on-polyethylene bearing surfaces in both clinical and laboratory experiments. Ceramic bearings can potentially improve total joint arthroplasty survivorship by decreasing debris induced periprosthetic osteolysis especially when used in the younger, high demand patient. This study presents the initial results of a new press-fit all-ceramic bearing undergoing clinical trials in the United States