title: Clinical outcomes of ceramicized ball heads in total hip replacement bearings: a literature review.
abstract: BACKGROUND
  Metallic ball heads for total hip replacement (THR) bearings with ceramicized surfaces were introduced in orthopedics during the second half of the 1980s, with the aim of decreasing the wear of polyethylene cups.
  
  
  METHODS
  An analysis was made of the literature regarding outcomes for metallic ball heads with ceramicized surfaces now in clinical use (TiN, TiNbN, ZrN, monoclinic ZrO2), as well as carbon coatings (pyrolytic carbon, diamond-like carbon) and silicon nitride as coatings in ball heads for THR bearings.
  
  
  RESULTS
  Notwithstanding the diffusion of ceramicized ball heads in THRs, there are few reports about their clinical outcomes in hip arthroplasty. In addition, several clinical studies and some registry data are putting under scrutiny the clinical advantages of ceramicized ball heads over cobalt chrome (CoCr) alloy and ceramic ball heads.
  
  
  CONCLUSIONS
  The wear of THR bearings with ceramicized ball heads looks like it depends more on the behavior of the polyethylene cups than on the treatment of the ball head surface. The risk of coating damage and of its consequences has to be taken into account in selecting this type of bearing.
authors.affiliation: Clinical Orthopedics and Traumatology Department, Catholic University of the Sacred Heart, Rome - Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Piconi
authors.affiliation: Clinical Orthopedics and Traumatology Department, Catholic University of the Sacred Heart, Rome - Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Santis
authors.affiliation: Clinical Orthopedics and Traumatology Department, Catholic University of the Sacred Heart, Rome - Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Maccauro
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D002516:Ceramics; D006622:Hip Prosthesis