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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2000 December;51(6):333-44
Myths and reality in the combination of biomaterials in artificial hips
Rossi P., Sibelli P., Marmotti A., Rossi R.
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The biomaterials currently used in hip replacement surgery have not yet achieved the ideal properties of joint cartilage. The sliding surfaces in prosthetic joints are subjects to wear, also because of the limited capacity of lubrification; this phenomenon influences the secondary biological stability of the artificial joint and its survival, linked to the extent of detritus production and consequent bone remodelling. The most commonly used biomaterials are very high molecular weight polyethylene, ceramics and metal. Currently there is no ideal material that combines optimal mechanical properties with absolute biocompatibility. In view of the limits presented by the current biomaterials, the choice of the combination is basically a compromise between the patient's real needs and the characteristics of the different materials available. Polyethylene maintains a primary role: artificial joints in polyethylene can be used in 75% of cases, whereas the ceramic-ceramic combination is only indicated in 20% of cases, in active young patients (aged between 30 and 50) with high functional requirements. The metal-metal combination is only used in a small percentage of active, heavyweight patients (5%) with a life expectancy of no more than 20 years. Future research on biomaterials will be aimed on the one hand at improving the characteristics of polyethylene and other materials currently in use, and on the other at the introduction of new materials and designs in order to produce artificial joints that are increasingly reliable over time.