During the past decade, advances in total hip arthroplasty component design have produced implants with reliable clinical results in regard to fixation. The foremost unresolved challenge has been the development of bearing surfaces that can withstand the higher demands of younger and more active patients. New alternative bearings with superior wear characteristics that minimize debris include ceramic-on-ceramic, metal-on-metal, and highly cross-linked polyethylenes in combination with ceramic or metal. Alumina-on-alumina ceramic bearings are extremely hard and scratch resistant and provide superior lubrication and wear resistance compared with other bearing surfaces in clinical use. Survivorship revision for any reason for the alumina ceramic bearings at 10 years was significantly higher compared with metal-on-polyethylene. Bearings currently being studied because of their encouraging wear performance in the laboratory are an alumina matrix (82% alumina, 17% zirconia, 0.3% chromium oxide), zirconium oxide, and ceramic-on-cobalt-chromium.
Perspectives on Modern Orthopaedics articles provide an objective appraisal of new or controversial techniques or areas of investigation in orthopaedic surgery.
Dr. D'Antonio is an active staff member at Sewickley Valley Hospital, Sewickley, PA. Ms. Sutton is Senior Manager, Academic Resources, Stryker Orthopaedics, Mahwah, NJ.
Dr. D'Antonio or a member of his immediate family has received research or institutional support, miscellaneous nonincome support, and royalties from Stryker, and is a consultant to or an employee of Stryker. Ms. Sutton is an employee of Stryker and holds stock or stock options in Stryker.
Reprint requests: Dr. D'Antonio, 1099 Ohio River Boulevard, Sewickly, PA 15143.