With an increasing demand for endoprosthetic treatment of patients leading an active and demanding lifestyle, the need for optimizing tribological properties of implants has arisen. Minimum wear rates are required in order to secure longevity of the implants.
In comparison to metal-on-polyethylene, ceramic-on-polyethylene or metal-on-metal bearings, ceramic-on-ceramic bearings show the lowest wear rates. The linear wear has been measured at 0.005 mm/year, and the volumetric wear at 0.04 mm3/year. Furthermore, the minimum risk of ionization of ceramic particles guarantees excellent biocompatibility. Excellent clinical results with a reported survival rate of more than 85% in cementless fixation at long-term follow-up of a mean 19.7 years have been documented .
However, ceramics still have a reputation of being unreliable due to first generation ceramics, which have been linked to an increased risk of fracture of ceramic components with reported fracture rates of up to 13.4%. Consequently, an uncertainty amongst surgeons developed, and other bearings were thus favoured. However, with the introduction of improved manufacturing processes and designs, the fracture rates could be dropped dramatically. The fracture rate reported for contemporary ceramic heads ranges from 0.002% to 0.2% propagated by the manufacturer (Source: Ceramtec™) to 0.004% and 1.4% in clinical reports, and the risk for liner fracture is assumed to be as low as 0.01–2%.
Ceramic-on-ceramic bearings have shed the stigma of high fracture rates and are nowadays acknowledged to be the material of choice for the high-demand, young and active patient.
Recently, numerous reports on audible phenomena generated by ceramic-on-ceramic bearings have been published and caused new concern. A distinct squeaking noise has been reported in between 0.3% and 10.7%.
Various other noises like clicking, grinding or grating can reach an incidence of 32.8%.
Up to date, the aetiology is still unclear and most likely multifactorial. Multiple studies have linked it to prosthetic design, malpositioning of components, edge loading, stripe wear, bone stock and patient activity levels.
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
Allain J, Goutallier D, Voisin MC, Lemouel S (1998) Failure of a stainless-steel femoral head of a revision total hip arthroplasty performed after a fracture of a ceramic femoral head. A case report. J Bone Joint Surg Am 80:1355–1360PubMedCrossRefGoogle Scholar
Allain J, Roudot-Thoraval F, Delecrin J, Anract P, Migaud H, Goutallier D (2003) Revision total hip arthroplasty performed after fracture of a ceramic femoral head: a multicenter survivorship study. J Bone Joint Surg 85:825–830PubMedGoogle Scholar
Back DL, Dalziel R, Young D, Shimmin A (2005) Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. J Bone Joint Surg Br 87(3):324–329PubMedCrossRefGoogle Scholar
Boehler M, Knahr K, Plenk H Jr, Walter A, Salzer M, Schreiber V (1994) Long-term results of uncemented alumina acetabular implants. J Bone Joint Surg Br 76-B:53–59Google Scholar
Boutin P (1972) Total arthroplasty of the hip by fritted aluminium prosthesis. Experimental study and 1st clinical applications. Rev Chir Orthop Reparatrice Appar Mot 58:29–46, FrenchGoogle Scholar
Brockett CL et al (2008) The influence of clearance on friction, lubrication and squeaking in large diameter metal- on- metal hip replacements. J Mater Sci Mater Med 19(4):1575–1579PubMedCrossRefGoogle Scholar
Campbell P et al (2004) Biologic and tribologic considerations of alternative bearing surfaces. Clin Orthop Relat Res 418(1):98–111PubMedCrossRefGoogle Scholar
Capello WN, D’Antonio JA, Feinberg JR et al (2008) Ceramic-on-ceramic total hip arthroplasty: update. J Arthroplasty 23(7 Suppl):39–43PubMedCrossRefGoogle Scholar
Chevillotte C, Trousdale RT, Chen Q, Guyen O, An K (2010) The 2009 Frank Stinchfield Award. “Hip squeaking”. A biomechanical study of ceramic-on-ceramic bearing surfaces. Clin Orthop Relat Res 468:345–350PubMedCrossRefGoogle Scholar
Clarke IC, Manaka M, Shishido T, Onishi H, Gustafson A, Boehler M (2003) Tribological and material properties for all-alumina THR – convergence with clinical retrieval data Bioceramics in Joint Arthroplasty 8th Biolox Symposium. Proceedings, 3–18Google Scholar
Clarke I, Manley MT (2008) How do alternate bearing surfaces influence wear behavior? J Am Acad Orthop Surg 16(Suppl 1):S86–S93PubMedGoogle Scholar
Clarke IC, Willmann G (1994) Structural ceramics in orthopaedics. In: Cameron H (ed) Bone implant interface. St. Louis, Mosby, pp 203–252Google Scholar
Dumbleton JH, Manley MT (2005) Metal-on-metal total hip replacement. What does the literature say? J Arthroplasty 20(2):174–188PubMedCrossRefGoogle Scholar
Elkins JS, O’Brien MK, Stroud NJ, Pedersen DR, Callaghan JJ, Brown TD (2011) Hard-on-hard total hip impingement causes extreme contact stress concentrations. Clin Orthop Relat Res 469:454–463PubMedCrossRefGoogle Scholar
Eskelinen A et al (2005) Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0–22 years. Acta Orthop 76:28–41PubMedCrossRefGoogle Scholar
Esposito C, Walter WL, Campbell P, Roques A (2010) Squeaking in metal-on-metal hip resurfacing arthroplasties. Clin Orthop Relat Res 468:2333–2339PubMedCrossRefGoogle Scholar
Fisher J, Jin Z, Tipper J, Stone M, Ingham E (2006) Tribology of alternative bearings. Clin Orthop Relat Res 453:25–34PubMedCrossRefGoogle Scholar
Glaser D, Komistek RD, Cates HE, Mahfouz MR (2008) Clicking and squeaking: in vivo correlation of sound and separation for different bearing surfaces. J Bone Joint Surg Am 90:112–120PubMedCrossRefGoogle Scholar
Grimm B, Tonino A, Heyligers IC (2011) Are noisy ceramic-on-ceramic hips linked to periprosthetic bone? Tribology in Total Hip Arthroplasty 2011, Part 2, 73–83Google Scholar
Griss P, Heimke G (1981) Five years’ experience with ceramic-metal-composite hip endoprostheses. I. Clinical evaluation. Arch Orthop Trauma Surg 98:157–164PubMedCrossRefGoogle Scholar
Hamadouche M, Boutin P, Daussange J, Bolander ME, Sedel L (2002) Alumina-on-alumina total hip arthroplasty: a minimum 18.5 year follow up study. J Bone Joint Surg Am 84:69PubMedGoogle Scholar
Hamilton W, McAuley J, Dennis D, Blumenfeld T, Politi J (2010) THA with delta ceramic. Clin Orthop Relat Res 468:358–366PubMedCrossRefGoogle Scholar
Hannouche D, Nich C, Bizot P, Meunier A, Nizard R, Sedel L (2003) Fractures of ceramic bearings: history and present status. Clin Orthop Relat Res 417:19–26PubMedGoogle Scholar
Heros RJ, Willmann G (1998) Ceramics in total hip arthroplasty: history, mechanical properties, clinical results, and current manufacturing state of the art. Semin Arthroplasty 9:114–122Google Scholar
Higuchi F, Shiba N, Inoue A, Wakebe I (1993) Fracture of an alumina head in total hip arthroplasty. J Arthroplasty 8:567–571CrossRefGoogle Scholar
Holzmann P, Eggli S, Ganz R (2002) Metal-on-metal: all things bright and beautiful in opposition. Orthopedics 25:932PubMedGoogle Scholar
Jarrett CA, Ranawat AS, Bruzzone M, Blum YC, Rodriguez JA, Ranawat CS (2009) The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am 91:1344–1349PubMedCrossRefGoogle Scholar
Keurentjes JC et al (2008) High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res 466:1438–1443PubMedCrossRefGoogle Scholar
Kim YH, Choi Y, Kim JS (2010) Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. Int Orthop 34(8):1123–1127, Epub 2009 Sep 26PubMedCrossRefGoogle Scholar
Koo KH, Ha YC, Jung WH, Kim SR, Yoo JJ, Kim HJ (2008) Isolated fracture of the ceramic head after third-generation alumina-on-alumina total hip arthroplasty. J Bone Joint Surg Am 90(2):329–336PubMedCrossRefGoogle Scholar
Kuntz M, Usbeck S, Pandorf T, Heros R (2011) Ceramic hip replacements: wear behaviour affects the outcome- a tribological and clinical approach. Tribol Total Hip Arthroplasty. doi:10.1007/987-3-642-19429-0_3
Lee Y-K, Ha Y-C, Yoo JJ, Koo K-H, Yoon KS, Kim HJ (2010) Alumina-on-alumina total hip arthroplasty: a concise follow-up, at a minimum of ten years, of a previous report. J Bone Joint Surg Am 92:1715–1719PubMedCrossRefGoogle Scholar
Lusty PJ, Tai CC, Sew-Hoy RP, Walter WL, Walter WK, Zicat BA (2007) Third generation alumina-on-alumina ceramic bearings in cementless total hip arthroplasty. J Bone Joint Surg Am 89:2676–2683PubMedCrossRefGoogle Scholar
Matar WY, Restrepo C, Javad P, Kurtz SM, Hozack WJ (2010) Revision hip arthroplasty for ceramic-on-ceramic squeaking hips does not compromise the results. J Arthroplasty 25(6 Suppl):81–86, Epub 15 Jul 2010PubMedCrossRefGoogle Scholar
Mittelmeier H (1985) Report on the first decennium of clinical experience with a cementless 267 ceramic total hip replacement. Acta Orthop Belg 51:367–376PubMedGoogle Scholar
Murphy SB et al (2006) Two-to 9 year clinical results of alumina ceramic-on-ceramic THA. Clin Orthop Relat Res 453:97–102PubMedCrossRefGoogle Scholar
Nevelos JE, Ingham E, Doyle C, Nevelos AB, Fisher J (2000) The influence of acetabular cup angle on the wear of “BIOLOX Forte” alumina ceramic bearing couples in a hip joint simulator. J Mater Sci Mater Med 12:141–144CrossRefGoogle Scholar
Nevelos J, Ingham E, Doyle C, Streicher R, Nevelos A, Walter W, Fisher J (2000) Microseparation of the centers of alumina-alumina artificial hip joints during simulator testing produces clinically relevant wear rates and patterns. J Arthroplasty 15:793–795PubMedCrossRefGoogle Scholar
Petsatodis GE, Papadopoulos PP, Papavasiliou KA, Hatzokos IG, Agathangelidis FG, Christodoulou AG (2010) Primary cementless total hip arthroplasty with an alumina ceramic-on-ceramic bearing: results after a minimum of twenty years of follow-up. J Bone Joint Surg Am 92(3):639–644PubMedCrossRefGoogle Scholar
Pospischill M, Knahr K (2005) Cementless total hip arthroplasty using a threaded cup and rectangular tapered stem. J Bone Joint Surg Br 87-B(9):1210–1215CrossRefGoogle Scholar
Restrepo C, Parvizi J, Kurtz SM, Sharkey PF, Hozack WJ, Rothman RH (2008) The noisy ceramic hip: is component malpositioning the cause? J Arthroplasty 23:643–649PubMedCrossRefGoogle Scholar
Restrepo C, Post Z, Kai B, Hozack W (2010) The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty. J Bone Joint Surg Am 92:550–557PubMedCrossRefGoogle Scholar
Salzer M, Zweymüller K, Locke H et al (1976) Further experimental and clinical experience 277 with aluminium oxide endoprostheses. J Biomed Mater Res 10:847–856PubMedCrossRefGoogle Scholar
Stewart TD et al (2003) Long term wear of ceramic-matrix composite material for hip prosthesis under severe swing phase microsimulation. J Biomed Mater Res Appl Biomater 66B:567–573CrossRefGoogle Scholar
Swanson T, Peterson DJ, Seethala R, Bliss R, Spellmon CA Jr (2010) Influence of prosthetic design on squeaking after ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 25(6 Suppl):36–42PubMedCrossRefGoogle Scholar
Tipper JL, Firkins PJ, Besong AA, Barbour PSM, Nevelos J, Stone MH, Ingham E, Fisher J (2001) Characterisation of wear debris from UHMWPE on zirconia ceramic, metal-on-metal and alumina ceramic-on-ceramic hip prostheses generated in a physiological anatomical hip joint simulator. Wear 250:120–128CrossRefGoogle Scholar
Toni A, Traina F, Stea S, Sudanese A, Visentin M, Bordini B, Squarzoni S (2006) Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience. J Bone Joint Surg Am 88(Suppl 4):55–63PubMedCrossRefGoogle Scholar
Toni A et al (2010) Osteolysis and ceramic-on-ceramic hip prostheses: “fact or fairy tale?”. In: Cobb J (ed) Modern trends in THA bearings. Material and clinical performance. Springer, Berlin/Heidelberg, pp 55–60Google Scholar
Walter WK (2005) Australian experience with ceramic systems. In: D’Antonio JA, Dietrich M (eds) Bioceramics and alternative bearings in joint arthroplasty. Steinkopff-Verlag, Darmstadt, pp 113–115CrossRefGoogle Scholar
Walter W, Insley GM, Walter WK, Tuke MA (2004) Edge loading in third generation alumina ceramic-on-ceramic bearings. J Arthroplasty 19:402–413PubMedCrossRefGoogle Scholar
Walter W, O’Toole GC, Walter WK, Ellis A, Zicat BA (2007) Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplasty 22(4):496–503PubMedCrossRefGoogle Scholar
Walter W, Waters TS, Gillies M, Donohoo S, Kurtz SM, Ranawat AS, Hozack WJ, Tuke MA (2008) Squeaking hips. J Bone Joint Surg Am 90:102–111PubMedCrossRefGoogle Scholar
Weiss C, Gdaniec P, Hoffmann N, Hothan A, Huber G, Morlock M (2010) Squeak in hip endoprosthesis systems: an experimental study and a numerical technique to analyse design variants. Med Eng Phys 32(6):604–660, Epub 16 Mar 2010PubMedCrossRefGoogle Scholar