Ceramic-Ceramic Bearing: Too Unpredictable to Use it Regularly
- Edwin P. Su MD
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
The purpose of this paper was to investigate the literature reporting the complications of ceramic bearings and attempt to provide insight into their implications.
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.
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.
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.
- Allain J, Roudot-Thoraval F, Delecrin J, Anract P, Migaud H, Goutallier D. Revision total hip arthroplasty performed after fracture of a ceramic femoral head. A multicenter survivorship study. J Bone Joint Surg Am. May 2003;85-A(5):825-830.
- Bernasek T, Fisher D, Dalury D, Levering M, Dimitris K. Is metal-on-metal squeaking related to acetabular angle of inclination? Clin Orthop Relat Res. Sep 2011;469(9):2577-2582. CrossRef
- Bragdon CR, Kwon YM, Geller JA, et al. Minimum 6-year followup of highly cross-linked polyethylene in THA. Clin Orthop Relat Res. Dec 2007;465:122-127.
- Callaway GH, Flynn W, Ranawat CS, Sculco TP. Fracture of the femoral head after ceramic-on-polyethylene total hip arthroplasty. J Arthroplasty. Dec 1995;10(6):855-859. CrossRef
- Capello WN, D'Antonio JA, Feinberg JR, Manley MT, Naughton M. Ceramic-on-ceramic total hip arthroplasty: update. J Arthroplasty. Oct 2008;23(7 Suppl):39-43. CrossRef
- Chevillotte C, Trousdale RT, Chen Q, Guyen O, An KN. The 2009 Frank Stinchfield Award: “Hip squeaking”: a biomechanical study of ceramic-on-ceramic bearing surfaces. Clin Orthop Relat Res. Feb 2010;468(2):345-350. CrossRef
- Choi IY, Kim YS, Hwang KT, Kim YH. Incidence and factors associated with squeaking in alumina-on-alumina THA. Clin Orthop Relat Res. Dec 2010;468(12):3234-3239. CrossRef
- Chotai PN, Su EP. Fracture of a titanium sleeve-encased third-generation ceramic liner in a modern THA. Orthopedics. Oct 2011;34(10):e682-684.
- Esposito C, Walter WL, Campbell P, Roques A. Squeaking in metal-on-metal hip resurfacing arthroplasties. Clin Orthop Relat Res. Sep 2010;468(9):2333-2339. CrossRef
- Ha YC, Kim SY, Kim HJ, Yoo JJ, Koo KH. Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. Clin Orthop Relat Res. May 2007;458:106-110.
- Habermann B, Ewald W, Rauschmann M, Zichner L, Kurth AA. Fracture of ceramic heads in total hip replacement. Arch Orthop Trauma Surg. Sep 2006;126(7):464-470. CrossRef
- Hamilton WG, McAuley JP, Dennis DA, Murphy JA, Blumenfeld TJ, Politi J. THA with Delta ceramic on ceramic: results of a multicenter investigational device exemption trial. Clin Orthop Relat Res. Feb 2010;468(2):358-366. CrossRef
- Hannouche D, Zaoui A, Zadegan F, Sedel L, Nizard R. Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty. Int Orthop. Feb 2011;35(2):207-213. CrossRef
- Jarrett CA, Ranawat AS, Bruzzone M, Blum YC, Rodriguez JA, Ranawat CS. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am. Jun 2009;91(6):1344-1349. CrossRef
- Keurentjes JC, Kuipers RM, Wever DJ, Schreurs BW. High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res. Jun 2008;466(6):1438-1443. CrossRef
- Kim YH, Choi Y, Kim JS. Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. Int Orthop. Dec 2010;34(8):1123-1127. CrossRef
- Lusty PJ, Tai CC, Sew-Hoy RP, Walter WL, Walter WK, Zicat BA. Third-generation alumina-on-alumina ceramic bearings in cementless total hip arthroplasty. J Bone Joint Surg Am. Dec 2007;89(12):2676-2683. CrossRef
- Mai K, Verioti C, Ezzet KA, Copp SN, Walker RH, Colwell CW, Jr. Incidence of ‘squeaking’ after ceramic-on-ceramic total hip arthroplasty. Clin Orthop Relat Res. Feb 2010;468(2):413-417. CrossRef
- McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB, Chess DG, Charron KD. Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. Apr 2009;91(4):773-782. CrossRef
- Parvizi J, Adeli B, Wong JC, Restrepo C, Rothman RH. A squeaky reputation: the problem may be design-dependent. Clin Orthop Relat Res. Jun 2011;469(6):1598-1605. CrossRef
- Restrepo C, Parvizi J, Kurtz SM, Sharkey PF, Hozack WJ, Rothman RH. The noisy ceramic hip: is component malpositioning the cause? J Arthroplasty. Aug 2008;23(5):643-649. CrossRef
- Restrepo C, Matar WY, Parvizi J, Rothman RH, Hozack WJ. Natural history of squeaking after total hip arthroplasty. Clin Orthop Relat Res. Sep 2010;468(9):2340-2345. CrossRef
- Restrepo C, Post ZD, Kai B, Hozack WJ. The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty. J Bone Joint Surg Am. Mar 2010;92(3):550-557. CrossRef
- Schroder D, Bornstein L, Bostrom MP, Nestor BJ, Padgett DE, Westrich GH. Ceramic-on-ceramic total hip arthroplasty: incidence of instability and noise. Clin Orthop Relat Res. Feb 2011;469(2):437-442. CrossRef
- Sexton SA, Yeung E, Jackson MP, et al. The role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements. J Bone Joint Surg Br. Apr 2011;93(4):439-442. CrossRef
- Stafford GH, Islam SU, Witt JD. Early to mid-term results of ceramic-on-ceramic total hip replacement: analysis of bearing-surface-related complications. J Bone Joint Surg Br. Aug 2011;93(8):1017-1020. CrossRef
- Swanson TV, Peterson DJ, Seethala R, Bliss RL, Spellmon CA. Influence of prosthetic design on squeaking after ceramic-on-ceramic total hip arthroplasty. J Arthroplasty. Sep 2010;25(6 Suppl):36-42. CrossRef
- Toni A, Sudanese A, Terzi S. Ceramics in Total Hip Arthroplasty. In: Wise DL, Trantolo DJ, Altobelli DE, eds. Encylopedic Handbook of Biomaterials and Bioengineering. New York: Marcel Dekker, Inc.; 1995:1501-1544.
- Toni A, Traina F, Stea S, et al. Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience. J Bone Joint Surg Am. Dec 2006;88 Suppl 4:55-63. CrossRef
- Walter WL, Insley GM, Walter WK, Tuke MA. Edge loading in third generation alumina ceramic-on-ceramic bearings: stripe wear. J Arthroplasty. Jun 2004;19(4):402-413. CrossRef
- Walter WL, O’Toole GC, Walter WK, Ellis A, Zicat BA. Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplasty. Jun 2007;22(4):496-503. CrossRef
- Walter WL, Waters TS, Gillies M, et al. Squeaking hips. J Bone Joint Surg Am. Nov 2008;90 Suppl 4:102-111. CrossRef
- Walter WL, Kurtz SM, Esposito C, et al. Retrieval analysis of squeaking alumina ceramic-on-ceramic bearings. J Bone Joint Surg Br. Dec 2011;93(12):1597-1601. CrossRef
- Willmann G. Ceramic femoral head retrieval data. Clin Orthop Relat Res. Oct 2000(379):22-28. CrossRef
- Ceramic-Ceramic Bearing: Too Unpredictable to Use it Regularly
HSS Journal ®
Volume 8, Issue 3 , pp 287-290
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- total hip arthroplasty
- bearing surfaces
- Edwin P. Su MD (1) (2)
- Author Affiliations
- 1. Clinical Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, 10065, USA
- 2. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA