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Online ISSN 1827-1707
HIP AND KNEE RECONSTRUCTION
Department of Orthopedic Surgery Orthotrauma Research Centre Amsterdam Amsterdam, the Netherlands
As long as the concept of total hip arthroplasty (THA) exists, we fail to provide 100% of our patients with a lifetime lasting optimal solution for their problem. This forces us to keep on exploring new options for THA designs. For the conventional THA, the bearing surfaces that could be used are the hard on soft being metal or ceramic (zirconia or alumina) on polyethylene (PE), or hard on hard in the form of metal-on-metal or ceramic-on-ceramic. None of the principles are new, although improvement of the tribology of the materials continues. For the PE highly crosslinking in radiation is now proven as a perfect alternative, and perhaps the second generation highly crosslinking with free radical scavengers will even lower wear and, consequently, even osteolysis. For ceramic-on-ceramic, many of the difficulties of the first and second generation are overcome in the current third generation, making it a safe and durable solution with minimal wear, however, with some specific problems like taper damage and squeaking, and how rare it may be, the problem of debris after fracturing. For metal-on-metal articulation the concern about the damage the released metal ions theoretically could produce and the concern regarding hypersensitivity remain its biggest enemies.