title: Hard bearing surfaces in total hip arthroplasty.
abstract: Periprosthetic osteolysis and aseptic loosening are serious problems affecting the outcome of total joint replacement. Polyethylene particulate debris generated from metal-on-polyethylene bearing surfaces and the resulting biologic response to this debris are thought to be largely responsible. As a result, there has been a renewal of interest in hard bearing surfaces for total joint arthroplasty, including both metal-on-metal and ceramic-on-ceramic components. The new-generation all-ceramic and all-metal prostheses have demonstrated, both clinically and in the laboratory, lower friction and wear rates than metal-on-polyethylene bearing surfaces. Theoretically, lower wear rates result in less particulate debris and decreased inflammatory response. Despite excellent tribologic (lubrication, friction, wear) properties, metal-on-metal bearings raise associated issues of metal sensitivity and toxicity. For ceramic-on-ceramic bearing surfaces, issues of ceramic quality and the possibility of brittle fracture must be considered.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Joint Diseases Orthopaedic Institute, New York, New York, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Jazrawi
authors.forename: F J
authors.initials: FJ
authors.lastname: Kummer
authors.forename: P E
authors.initials: PE
authors.lastname: Di Cesare
mesh_terms: D001672:Biocompatible Materials / Q000009:adverse effects* / Q000737:chemistry; D002516:Ceramics / Q000009:adverse effects* / Q000737:chemistry; D006244:Hardness; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007249:Inflammation; D008670:Metals / Q000009:adverse effects* / Q000737:chemistry; D010014:Osteolysis / Q000209:etiology*; D011095:Polyethylenes / Q000009:adverse effects* / Q000737:chemistry; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013499:Surface Properties; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D008670:Metals; D011095:Polyethylenes