Ceramic-Ceramic Bearing: Too Unpredictable to Use it Regularly


Edwin P. Su, MD

Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery

Abstract

Background: 
Ceramic-on-ceramic (CoC) bearings have excellent tribologic properties because of the smoothness, hardness, and wettability of the material. Therefore, their use has been proposed in younger, active patients who may wear out a traditional metal-on-polyethylene bearing. The same material properties that are beneficial to tribology may also create problems, however. For example, squeaking and fracture of the bearing materials have been reported to occur.

Purpose: 
The purpose of this paper was to investigate the literature reporting the complications of ceramic bearings and attempt to provide insight into their implications.

Methods: 
The US National Library of Medicine Database (PubMed) was searched using the terms “ceramic-ceramic total hip replacement,” “complications,” “squeaking,” and “fracture.” Only clinical studies with a clear reporting of the incidence of these complications were included.

Results: 
The literature reports that squeaking of the CoC bearing occurs in a certain percentage of patients and is likely indicative of edge loading and excessive wear. Other factors, such as patient height, weight, range of motion, and implant design, may contribute to the propensity for squeaking. Fracture is a unique risk of the CoC articulation that requires revision surgery. Though improvements in manufacturing techniques have reduced the fracture risk to a very low percentage, the ceramic material remains susceptible to this complication by impingement and component malposition.

Conclusions: 
Because of these possible negative outcomes associated with the ceramic material, the CoC bearing is too unpredictable to use regularly, and its use should be limited to patients who would benefit the most from it.

This article appears in HSS Journal: Volume 8, Number 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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