Abstract
The long-term durability of polyethylene lining total hip arthroplasty (THA) mainly depends on periprosthetic osteolysis due to wear particles, especially in young active patients. In hip simulator study, reports revealed significant wear reduction of the alumina ceramic-on-polyethylene articulation of THA compared with metal-on-polyethylene bearing surfaces. However, medium to long-term clinical studies of THA using the alumina ceramic-on-polyethylene are few and the reported wear rate of this articulation is variable. We reviewed the advantages and disadvantages of ceramicon- polyethylene articulation in THA, hip simulator study and retrieval study for polyethylene wear, in vivo clinical results of THA using alumina ceramic-on-polyethylene bearing surfaces in the literature, and new trial alumina ceramic-onhighly cross linked polyethylene bearing surfaces.
Highlights
Alumina ceramic was introduced as a bearing surface in the 1971 as an alternative to the metal on-polyethylene couplings
There are different wear rate in hip simulator studies and retrieval studies about alumina ceramic-onpolyethylene articulation, the clinical wear performances of these articulations in total hip arthroplasty (THA) showed significant reduction of polyethylene wear compared with meta-on-polyethylene articulation
Incidence of alumina ceramic head fracture was rare compared with ceramic-on-ceramic bearing surfaces
Summary
Alumina ceramic was introduced as a bearing surface in the 1971 as an alternative to the metal on-polyethylene couplings. Alumina 1980s (second generation) had a reduced microstructure grain size, had a laser marking, and sintered in air. The advantages of using alumina ceramic as a bearing surface in THA are related to its hardness, wettability, fluid film lubrication, inertness, high level of oxidation of alumina ceramic which provide resistance to scratches, and high biocompatibility [1, 2]. These characteristics seem to make less polyethylene wear when alumina ceramic head articulates with polyethylene than metal head. The disadvantages of alumina ceramic-on-polyethylene bearing surfaces involves the risk of alumina head fracture and the resultant difficult revision surgery [3], and metal transfer which can increase surface roughness and third body wear leading to increased polyethylene wear [4]
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