Abstract
Pure alumina ceramic has been in clinical use in orthopaedics since 1971 and, currently, up to 5 million components have been implanted. Alumina offers advantages like stability, biocompatibility and low wear; however, it has limited strength. Applications are limited by design considerations. Engineers in biomaterials have worked on improving the performance of the material by optimising the manufacturing process. To fulfil surgeons’ and patients’ increasingly exacting requirements, ceramists have also developed a new ceramic composite, the alumina matrix composite (AMC). This material combines the great principles of the reinforcement of ceramics with its tribological qualities and presents a better mechanical resistance than alumina. The examination of the tribological situation of AMC, especially under the challenging conditions of hydrothermal ageing, shows the aptitude of this material in wear applications. The US Food and Drug Administration (FDA) has approved ceramic ball heads articulating against polyethylene inserts. Since its introduction, more than 65,000 ball heads and 40,000 inserts of AMC have been implanted. With a 6-year follow up, no complication has been reported to the manufacturer. Improved toughness and the excellent wear of AMC makes it a potentially more flexible alternative to the more traditional alumina for hip prostheses.
Résumé
Les têtes en céramique d’alumine pure sont utilisées en orthopédie depuis 1971, plus de 5 millions de composants ont été implantés. L’alumine offre les avantages suivant: stabilité, biocompatibilité et usure minime cependant, sa fragilité peut être une limite. L’utilisation peut être limitée également du fait du type de design. Les ingénieurs en biomécanique ont travaillé de façon à améliorer les performances de ce type de matériau en optimisant le processus de fabrication. Ils ont également essayé de développer de nouvelles céramiques composites de type Alumina Matrix Composite (AMC). Ce matériel permet d’associer les grands principes de la céramique et d’améliorer sa résistance de même en ce qui concerne ses qualités tribologiques. Les conditions d’études tribologiques, en augmentant le vieillissement restent satisfaisantes. La FDA a approuvé l’utilisation de ces têtes céramiques avec un couple céramique/polyéthylène. Depuis son introduction plus de 60.000 têtes et 40.000 inserts d’AMC ont été implantés avec un suivi moyen de 6 ans sans complications rapportées. L’amélioration de la dureté et son excellente résistance à l’usure font de ce matériau une alternative satisfaisante à l’alumine traditionnelle pour les prothèses totales de hanche.
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Masson, B. Emergence of the alumina matrix composite in total hip arthroplasty. International Orthopaedics (SICOT) 33, 359–363 (2009). https://doi.org/10.1007/s00264-007-0484-9
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DOI: https://doi.org/10.1007/s00264-007-0484-9