Total hip replacements with ceramic-on-ceramic bearings

Introduction: The first generation of ceramic-on-ceramic bearings was introduced in France in 1970s. The quality of material as well as the design of ceramic components were improved in the second generation developed in 1980s. The contemporary, third generation of ceramic-on-ceramic bearings has been in use since mid 1990s. Characteristics: In vivo wear of ceramic-on-ceramic bearings is very low, <1 mm(3)/year. Ceramic wear particles formed under conditions of normal wear are nanometer-sized. Despit a common belief, these particles are not completely biologically inert. The incidence of ceramic component fracture is low. Clinical results: Long-term data for the first generation of ceramic-on-ceramic bearings show more than 60% survival at 20 years. Currently, mid-term results of the third generation are available. Although the incidence of osteolysis is significantly lower than for metal-on-polyethylene bearings, it is not possible to avoid it completely. Conclusions: Total hip replacements with ceramic-on-ceramic bearings show very low wear, the incidence of osteolysis is low and there are no biocompatibility issues, as is the case with metal-on-metal bearings. The possibility of ceramic component fracture is small, however, when it happens it is always a serious complication.