Abstract
Alumina-on-alumina bearings in total hip arthroplasty have been developed in an attempt to minimise debris and the occurrence of osteolytic lesions. The outstanding tribological properties of this bearing system are explained by low surface roughness, high hardness for major scratch resistance, and high wettability. Since the 1970s, technological improvements in the manufacturing process of alumina components together with a better understanding of Morse taper technology have provided a surgical grade material with high density, high purity and small grains. Published studies on the outcome of total hip arthroplasty performed with this new generation of implants showed high survivorship especially in young and active patients, with survival rates free of revision of 90.8% to 97.4% at ten years. However, concern remains over ceramic liner fracture and squeaking, which has been noted recently with increasing prevalence. This review will discuss the current knowledge on the use of alumina-on-alumina bearings.
Similar content being viewed by others
References
Boutin P (1971) Alumina and its use in surgery of the hip. (Experimental study). Presse Méd 79:639–640
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 19–26
Nizard RS, Sedel L, Christel P, Meunier A, Soudry M, Witvoet J (1992) Ten-year survivorship of cemented ceramic-ceramic total hip prosthesis. Clin Orthop 53–63
Bizot P, Banallec L, Sedel L, Nizard R (2000) Alumina-on-alumina total hip prostheses in patients 40 years of age or younger. Clin Orthop Relat Res 68–76
Hamadouche M, Nizard RS, Meunier A, Bizot P, Sedel L (1999) Cementless bulk alumina socket: preliminary results at 6 years. J Arthroplasty 14:701–707
Bizot P, Larrouy M, Witvoet J, Sedel L, Nizard R (2000) Press-fit metal-backed alumina sockets: a minimum 5-year followup study. Clin Orthop Relat Res 134–142
Garcia-Rey E, Cruz-Pardos A, Garcia-Cimbrelo E (2009) Alumina-on-alumina total hip arthroplasty in young patients: diagnosis is more important than age. Clin Orthop Relat Res 467:2281–2289
Bascarevic Z, Vukasinovic Z, Slavkovic N, Dulic B, Trajkovic G, Bascarevic V, Timotijevic S (2010) Alumina-on-alumina ceramic versus metal-on-highly cross-linked polyethylene bearings in total hip arthroplasty: a comparative study. Int Orthop 34:1129–1135
Ha YC, Kim SY, Kim HJ, Yoo JJ, Koo KH (2007) Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. Clin Orthop Relat Res 458:106–110
Ranawat AS, Ranawat CS (2007) The squeaking hip: a cause for concern-agrees. Orthopedics 30(738):743
Walter WL, Waters TS, Gillies M, Donohoo S, Kurtz SM, Ranawat AS, Hozack WJ, Tuke MA (2008) Squeaking hips. J Bone Joint Surg Am 90(Suppl 4):102–111
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 91:1344–1349
Hannouche D, Hamadouche M, Nizard R, Bizot P, Meunier A, Sedel L (2005) Ceramics in total hip replacement. Clin Orthop Relat Res 62–71
Christel PS (1992) Biocompatibility of surgical-grade dense polycrystalline alumina. Clin Orthop 10–18
Hoffinger SA, Keggi KJ, Zatorski LE (1991) Primary ceramic hip replacement: a prospective study of 119 hips. Orthopedics 14:523–531
Mittelmeier H, Heisel J (1992) Sixteen-years' experience with ceramic hip prostheses. Clin Orthop 64–72
Walter IA (1992) On the material and tribology of alumina-alumina couplings for hip joint prostheses. Clin Orthop 282:31–46
Boutin P, Christel P, Dorlot JM, Meunier A, de Roquancourt A, Blanquaert D, Herman S, Sedel L, Witvoet J (1988) The use of dense alumina-alumina ceramic combination in total hip replacement. J Biomed Mater Res 22:1203–1232
Clarke IC, Good V, Williams P, Schroeder D, Anissian L, Stark A, Oonishi H, Schuldies J, Gustafson G (2000) Ultra-low wear rates for rigid-on-rigid bearings in total hip replacements. Proc Inst Mech Eng H 214:331–347
Prudhommeaux F, Hamadouche M, Nevelos J, Doyle C, Meunier A, Sedel L (2000) Wear of alumina-on-alumina total hip arthroplasties at a mean 11-year followup. Clin Orthop Relat Res 113–122
Petit A, Catelas I, Antoniou J, Zukor DJ, Huk OL (2002) Differential apoptotic response of J774 macrophages to alumina and ultra-high-molecular-weight polyethylene particles. J Orthop Res 20:9–15
Catelas I, Petit A, Zukor DJ, Marchand R, Yahia L, Huk OL (1999) Induction of macrophage apoptosis by ceramic and polyethylene particles in vitro. Biomaterials 20:625–630
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-A:69–77
Bizot P, Hannouche D, Nizard R, Witvoet J, Sedel L (2004) Hybrid alumina total hip arthroplasty using a press-fit metal-backed socket in patients younger than 55 years. A six- to 11-year evaluation. J Bone Joint Surg Br 86:190–194
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 92:639–644
Kress AM, Schmidt R, Holzwarth U, Forst R, Mueller LA (2010) Excellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up. Int Orthop. doi:10.1007/s00264-010-1150-1
Bohler M, Mochida Y, Bauer TW, Plenk H Jr, Salzer M (2000) Wear debris from two different alumina-on-alumina total hip arthroplasties. J Bone Joint Surg Br 82:901–909
Brown C, Williams S, Tipper JL, Fisher J, Ingham E (2007) Characterisation of wear particles produced by metal on metal and ceramic on metal hip prostheses under standard and microseparation simulation. J Mater Sci Mater Med 18:819–827
Fye MA, Huo MH, Zatorski LE, Keggi KJ (1998) Total hip arthroplasty performed without cement in patients with femoral head osteonecrosis who are less than 50 years old. J Arthroplasty 13:876–881
Gualtieri G, Nigrisoli M, Dallari D, Catamo L, Gualtieri I (1993) A study of the mechanical and biological behavior of bioceramic hip arthroplasty followed-up after more than 10 years. Chir Organi Mov 78:213–222
Huo MH, Martin RP, Zatorski LE, Keggi KJ (1995) Ceramic total hip replacement done without cement. Long term follow-up study. Orthop Trans 19:400–401
Hernigou P, Zilber S, Filippini P, Poignard A (2009) Ceramic-ceramic bearing decreases osteolysis: a 20-year study versus ceramic-polyethylene on the contralateral hip. Clin Orthop Relat Res 467:2274–2280
Ilchmann T, Neher S, Maurer F, Weise K (2007) Modes of failure of a threaded acetabular cup: a radiographic study with EBRA of 42 revised cups. Int Orthop 31:211–216
Mochida Y, Boehler M, Salzer M, Bauer TW (2001) Debris from failed ceramic-on-ceramic and ceramic-on-polyethylene hip prostheses. Clin Orthop Relat Res 113–125
Hatton A, Nevelos JE, Matthews JB, Fisher J, Ingham E (2003) Effects of clinically relevant alumina ceramic wear particles on TNF-alpha production by human peripheral blood mononuclear phagocytes. Biomaterials 24:1193–1204
Willmann G (2000) Ceramic femoral head retrieval data. Clin Orthop Relat Res 379:22–28
Heck DA, Partridge CM, Reuben JD, Lanzer WL, Lewis CG, Keating EM (1995) Prosthetic component failures in hip arthroplasty surgery. J Arthroplasty 10:575–580
Kempf I, Semlitsch M (1990) Massive wear of a steel ball head by ceramic fragments in the polyethylene acetabular cup after revision of a total hip prosthesis with fractured ceramic ball. Arch Orthop Trauma Surg 109:284–287
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 80:1355–1360
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 Am 85-A:825–830
Sharma V, Ranawat AS, Rasquinha VJ, Weiskopf J, Howard H, Ranawat CS (2010) Revision total hip arthroplasty for ceramic head fracture: a long-term follow-up. J Arthroplasty 25:342–347
Hannouche D, Delambre J, Zadegan F, Sedel L, Nizard R (2010) Is there a risk in placing a ceramic head on a previously implanted trunion? Clin Orthop Relat Res 468:3322–3327
Baek SH, Kim SY (2008) Cementless total hip arthroplasty with alumina bearings in patients younger than fifty with femoral head osteonecrosis. J Bone Joint Surg Am 90:1314–1320
Keurentjes JC, Kuipers RM, Wever DJ, Schreurs BW (2008) High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res 466:1438–1443
Schroder D, Bornstein L, Bostrom MP, Nestor BJ, Padgett DE, Westrich GH (2010) Ceramic-on-ceramic total hip arthroplasty: incidence of instability and noise. Clin Orthop Relat Res. Sep 18 [Epub ahead of print]
Restrepo C, Matar WY, Parvizi J, Rothman RH, Hozack WJ (2010) Natural history of squeaking after total hip arthroplasty. Clin Orthop Relat Res 468:2340–2345
Taylor S, Manley MT, Sutton K (2007) The role of stripe wear in causing acoustic emissions from alumina ceramic-on-ceramic bearings. J Arthroplasty 22:47–51
Chevillotte C, Trousdale RT, Chen Q, Guyen O, An KN (2010) The 2009 Frank Stinchfield Award: “Hip squeaking”: a biomechanical study of ceramic-on-ceramic bearing surfaces. Clin Orthop Relat Res 468:345–350
Walter WL, Insley GM, Walter WK, Tuke MA (2004) Edge loading in third generation alumina ceramic-on-ceramic bearings: stripe wear. J Arthroplasty 19:402–413
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 15:793–795
Restrepo C, Post ZD, Kai B, Hozack WJ (2010) The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty. J Bone Joint Surg Am 92:550–557
Pulliam IT, Trousdale RT (1997) Fracture of a ceramic femoral head after a revision operation. A case report [see comments]. J Bone Joint Surg Am 79:118–121
Author information
Authors and Affiliations
Corresponding author
Additional information
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
Rights and permissions
About this article
Cite this article
Hannouche, D., Zaoui, A., Zadegan, F. et al. Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty. International Orthopaedics (SICOT) 35, 207–213 (2011). https://doi.org/10.1007/s00264-010-1187-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-010-1187-1