Ceramic-on-Ceramic Bearings in Hip Arthroplasty: A Clinical Review

  • James M. BuchananEmail author
  • James M. Buchanan


Fixation of prosthetic implants is vital, and failure from loosening needs to be avoided if possible. Cement fixation is improving with advanced insertion techniques, but long-term use of cement beyond 10 years is still a worry. To compound the worries, polythene wear will cause periprosthetic osteolysis from debris disease. Fixation using the physiological process of bony integration of synthetic hydroxyapatite (HA) will obviate the use of cement. An HA-coated implant will become integrated and thereby fixed in cancellous bone. It is postulated that stem cells in the bone marrow will adhere to the HA coating and then become osteocytes, thereby fixing the implant.

Fixation may outlast the bearing surfaces. With over 20 years experience, results from HA fixation suggest that it is a reliable system, but we know that polythene bearings continue to wear and need isolated revision.


Aseptic Loosening Polythene Wear Bearing Surface Periprosthetic Osteolysis Synthetic Hydroxyapatite 
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.


  1. 1.
    Boutin P (1972) Total arthroplasty of the hip by fritted alumina prosthesis. Rev Chir Orthop Reparatrice Appar Mot 58(3):229–246PubMedGoogle Scholar
  2. 2.
    Buchanan JM, Goodfellow S (2008) Nineteen year review of hydroxyapatite ceramic coated hip implants: a clinical and histological evaluation. Key Eng Mater 361–363:1315–1318, ISBN 1013–9826, ISBN 0–87849–457-x, ISBN-13–978–0–87849–457–6CrossRefGoogle Scholar
  3. 3.
    Buchanan JM, Malcolm AJ (2004) Fifteen year review of hydroxyapatite ceramic coated hip implants: a clinical and histological evaluation. J Bone Joint Surg Br 86-B(Suppl 111):320Google Scholar
  4. 4.
    D’Antonio JA, Capello WN, Manley MT, Geesink R (2001) Hydroxyapatite stems for total hip arthroplasty. Clin Orthop Relat Res 393:101–111PubMedCrossRefGoogle Scholar
  5. 5.
    Daviers AP, Willert HG, Campbell PA, Learmonth ID, Case CP (2005) An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am 87A:18–27CrossRefGoogle Scholar
  6. 6.
    Doorn PF (2000) Wear and biological aspects of metal-on-metal total hip replacements. Thesis, University Medical Centre Nijmegen, Nijmegen, October 2000Google Scholar
  7.  7.
    Doorn PF, Mirra PF, Campbell PA, Amstutz HC (1996) Tissue reaction to metal-on-metal total hip prostheses. Clin Orthop Relat Res 329S:S187–S205CrossRefGoogle Scholar
  8.  8.
    Dumbleton JH et al (2002) A literature review of the association between wear rate and osteolysis in total hip arthroplasty. J Arthroplasty 17:649–661PubMedCrossRefGoogle Scholar
  9.  9.
    Furlong RJ, Osborn JF (1991) Fixation of hip prostheses by hydroxyapatite coatings. J Bone Joint Surg Br 73-B:741–745Google Scholar
  10. 10.
    Geesink RGT, Hoefnagels NHM (1992) Six years results of hydroxylapatite coated total hip replacement. J Bone Joint Surg Br 74-B:74–77Google Scholar
  11. 11.
    Geesink RGT, de Groot K, Klein CPAT (1988) Bonding of bone to apatite coated implants. J Bone Joint Surg Br 70-B:17–22Google Scholar
  12. 12.
    Greenwald AS, Garino JP (2001) Alternate bearing surfaces: the good, the bad and the ugly. J Bone Joint Surg 83-A(Suppl 2, part 2):68–72, Metal-on-metal total hip replacementsPubMedGoogle Scholar
  13. 13.
    Jacobs JJ, Skipor AK, Doorn PF, Campbell PA, Schmalzried TP, Black J, Amstutz HC (1996) Cobalt and chromium concentrations in patients with metal-on-metal total hip replacements. Clin Orthop 329S:S256–S263Google Scholar
  14. 14.
    Kwon YM, Ostlere S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CLM, Taylor A, Pandit HS, Glyn-Jones P, Athanson N, Beard D, Gull HC, Murray DW (2009) Asymptomatic pseudotumours in patients with metal-on-metal hip resurfacing: prevalence and metal ion study. Presented at annual scientific meeting British Hip Society, Manchester, 2009Google Scholar
  15. 15.
    Laughton DJ, Jameson SS, Joyce TJ, Natu S, Logishetty R, Tulloch C, Nargol AV (2009) Adverse reactions to metal debris following large bearing metal-on-metal arthroplasty. Presented at annual scientific meeting British Hip Society, Manchester, 2009Google Scholar
  16. 16.
    Murray DW (2008) Pseudotumour after hip resurfacing. Presented at second annual U.S. comprehensive course on total hip resurfacing arthroplasty, Los Angeles, 24–25 Oct 2008Google Scholar
  17. 17.
    Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CLM, Ostlere S, Athanasou N, Gill HS (2008) Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br 90-B:847–851CrossRefGoogle Scholar
  18. 18.
    Sedel L, Hamadouche M, Bizot P, Nizard R (2003) Long term data concerning the use of alumina on alumina bearings in total hip replacements. Key Engineering Materials 240–242:769–772. BIOCERAMICS 15; Trans Tech Publications Ltd, Switzerland ISBN 0-87849-911-3CrossRefGoogle Scholar
  19. 19.
    Søballe K, Hansen ES, Brockstedt-Rasmussen H et al (1990) Hydroxyapatite coating enhances fixation of porous coated implants: a comparison in dogs between press-fit and non-interference fit. Acta Orthop Scand 61:299–306PubMedCrossRefGoogle Scholar
  20. 20.
    Tonino A, Thèrin M, Doyle C (1999) Histology and histomorphometry around autopsy components. J Bone Joint Surg Br 81-B:148–154CrossRefGoogle Scholar

Copyright information

© EFORT 2012

Authors and Affiliations

  1. 1.Sunderland Royal HospitalSunderlandUK
  2. 2.University of Newcastle upon TyneNewcastle upon TyneUK

Personalised recommendations