Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty

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.

Alumina-on-alumina THA Performed in Patients Younger Than 30 Years: A 10-year Minimum Followup Study

“…However, the possibility of ceramic fracture still poses a challenge [16]. In the current study, one ceramic fracture occurred as a result of inadequate hip muscle tone after spinal cord injury, and after experience of this failure, we no longer use alumina-on-alumina articulation in patients at risk of repetitive subluxation and relocation.…”

“…These bearings are characterized by low surface roughness, high hardness for major scratch resistance, and high wettability [16]. The low wear rates of alumina-on-alumina bearings reportedly reduce osteolysis and preserve bone stock, both of which are important considerations in young patients who are expected to require revision surgery at some stage [10,19].…”

Ceramic-on-ceramic THA Implants in Patients Younger Than 20 Years

“…Ceramic-on-ceramic bearing couples have become an alternative to standard surface bearing couples (such as metal-on-polyethylene) because of decreased wear production and lower rates of osteolytic lesions compared with metal-on-conventional polyethylene [21]. The results of modern ceramic-on-ceramic bearings are available in patients younger than 60 years who have degenerative diseases [2,3,16,29,30], but few reports [6,15,23] have focused on patients younger than 20 years, who may be more likely to have high activity levels, perform sports activities, or engage in higher-demand workplace tasks.…”

CORR Insights®: Do Alumina Matrix Composite Bearings Decrease Hip Noises and Bearing Fractures at a Minimum of 5 Years After THA?

“…There is no demonstration of the superiority in the long-term of this alumina matrix composite compared with a regular modern pure alumina ceramic [6,8]. In fact, it appears that evidence is emerging in support of biological advantages of pure alumina ceramic that were postulated years ago [3].…”

“…Ceramic bearings are advantageous because they have a low volume of wear debris, high biocompatibility of the particles that are generated, and increased wettability of the surface compared to other friction couples. Previous studies [4,6,8] have demonstrated the long-term limited observation of osteolysis and a low frequency of revisions even in active and young patients, some of whom practice sports. One study [7] reported on the stability of pure alumina ceramic over time.…”