Ceramics for prosthetic hip and knee joint replacement

The most commonly used bearing couple in prosthetic hip or knee joint replacements consists of a cobalt-chrome (CoCr) metal alloy articulating against ultrahigh-molecular-weight polyethylene. Ceramics have been used as an alternative to metal-on-polyethylene in joint replacement surgery of arthritic hips and knees since the 1970s. In prosthetic hip and knee bearings, ceramic surfaces offer a major benefit of drastically reduced wear rates and excellent long-term biocompatibility, which can increase the longevity of prosthetic hip and knee joints. This benefit is important clinically because hip and knee replacement has become a very common surgical procedure, particularly in the United States, and because these procedures are being increasingly performed in younger patients who place greater demands on the prosthetic bearings. However, ceramics are brittle and the risk of catastrophic bearing failure in vivo, while rare, is a major concern. Improvements in material quality, manufacturing methods, and implant design have resulted in a drastic reduction of the incidence of such failures, so that modern ceramic bearings are safe and reliable if used with components of proven design and durability. Future material improvements are actively being investigated to reduce the risk of ceramic-bearing failures even further. The purpose of this article is to review the structure, properties, applications, and limitations of the ceramics that have been used in orthopedic bearings, and to describe the new ceramic composite materials and surface treatments that will be available for joint replacement surgery in the near future.