CORR Insights®: Do Alumina Matrix Composite Bearings Decrease Hip Noises and Bearing Fractures at a Minimum of 5 Years After THA?

Abstract

T he implantation of alumina ceramic bearings in total hip replacement began around 45 years ago. Ceramic bearings are advantageous because they have a low volume of wear debris, high biocompatibility of the particles that are generated, and increased wettability of the surface compared to other friction couples. Previous studies [4, 6, 8] have demonstrated the long-term limited observation of osteolysis and a low frequency of revisions even in active and young patients, some of whom practice sports. One study [7] reported on the stability of pure alumina ceramic over time. This study also examined the dense fibrous tissue that might diminish the long-term risk of hip dislocation, an interesting biological reaction to pure alumina ceramics. However, concerns about fractures have justified the search for other materials. The introduction of an alumina matrix composite material, Delta ceramics (CeramTec, Plochingen, Germany), could potentially reduce the risk of dislocation by allowing for a larger head and thinner liner [5]. This material, which includes embedded zirconia particles, is believed to provide an improved fracture resistance during the initial phase [1, 2]. The zirconia particles in the alumina matrix composite bearing can stop a crack from spreading by changing its phase from tetragonal to monoclinic. Does this phase modification have any impact on long-term ceramic resistance? The current study does not answer this question, but rather focuses on short-term results. The current study by Baek and colleagues examined the frequency of bearing-related complications regarding alumina matrix composite ceramic bearings in cementless THA. The authors also determined the Harris Hip Scores and calculated the survivorship free from reoperation and revision at a minimum of 5 years after cementless THA performed with alumina matrix composite ceramic bearings. The authors described one case of liner dissociation that could be related to the large cone angle (18.5 ) of the construct. Regarding noise generation, they found two cases of click, which may be related to some form of limited This CORR Insights is a commentary on the article ‘‘Do Alumina Matrix Composite Bearings Decrease Hip Noises and Bearing Fractures at a Minimum of 5 Years After THA?’’ by Baek and colleagues available at: DOI: 10.1007/s11999-015-4428-1. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0154428-1. L. Sedel MD (&) Service de Chirurgie Orthopedique, Hopital Lariboisiere, 2 rue Ambroise Pare, 75475 Cedex 10 Paris, France e-mail: laurent.sedel@aphp.fr; laurent.sedel@lrb.aphp.paris.fr CORR Insights Published online: 23 July 2015 The Association of Bone and Joint Surgeons1 2015