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Online ISSN 1827-1707
CURRENT TRENDS IN MODERN HIP SURGERY TRENDS AND REAL INNOVATIONS IN THE 1° IMPLANT
MATING SURFACES IN HIP ARTHROPLASTY
Rossi P., Castoldi F., Rossi R., Fantino G., Blonna D., Dettoni F., Buzzone M.
Divisione Universitaria di Ortopedia e Traumatologia Ospedale Mauriziano “Umberto I “, Torino
Ceramic-on-ceramic total hip arthroplasty has continued to evolve and has enjoyed success in European centers throughout the past 3 decades. Alumina was the first ceramic developed as a bearing surface. Zirconia evolved as a biomaterial because of its higher tensile strength, further reducing the risk of fracture and allowing smaller head sizes and longer neck lengths. Most of the failures reported in literature were attributable to design specific and material specific flaws. Since then, many improvements have been made in ceramic manufacturing leading to even more superior mechanical properties and wear characteristics. The material properties that make ceramics a desirable bearing surface are their hardness, wettability, and biocompatibility. These material properties mean less volumetric wear, smaller particle size, and decreased cytotoxicity when compared with polyethylene. However, despite the many advantages that exist because of the latest technology and advances in ceramic manufacturing, there still are significant limitations to their applicability: the continued risk of fracture, the potential for wear of the ceramic articulation, generation of debris from new modular interfaces, impingement and neck damage, and the substantial loss of head and liner options. Conditions associated with ceramic wear include vertical cup position, femoral neck impingement, and femoral head separation during gait. Catastrophic failure, although rare, continues to be a concern, and not all fractures can be predicted by proof testing. Revisions needed because of ceramic fractures can be extensive, and the results of the revision procedures can be compromised by the presence of highly abrasive particulate debris that is retained.