Ceramic on Ceramic

  • Eustathios Kenanidis
  • Panagiotis Kakoulidis
  • Eleftherios TsiridisEmail author


Alumina ceramic is a highly oxidized ceramic that is formed by the fusion of microscopic grains of alumina (Al2O3) and/or zirconia (ZrO2) ceramic powder into a solid phase. During the process of sintering known as “hot isostatic pressing,” the agents are pressed above 1000 bars and sintered at 1600 °C [1]. Then, the components are polished to get the finest surface possible. This hard material is also hydrophilic and highly polished and has better biocompatibility than metal ions. These unique characteristics were used in THA to decrease wear rate and osteolysis [1].


  1. 1.
    Hannouche D, Zaoui A, Zadegan F, Sedel L, Nizard R. Thirty years of experience with alumina-on-alumina bearings in total hip arthroplasty. Int Orthop. 2011;35:207–13.CrossRefPubMedGoogle Scholar
  2. 2.
    Su EP. Ceramic-ceramic bearing: too unpredictable to use it regularly. HSS J. 2012;8:287–90.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Massina P, Lopesb R, Massonc B, Mainard D, The French Hip & Knee Society (SFHG). Does Biolox® Delta ceramic reduce the rate of component fractures in total hip replacement? Orthop Traumatol Surg Res. 2014;100:S317–21.CrossRefGoogle Scholar
  4. 4.
    Gallo J, Goodmanb SB, Lostaka J, Janouta M. Advantages and disadvantages of ceramic on ceramic total hip arthroplasty: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012;156(3):204–12.CrossRefPubMedGoogle Scholar
  5. 5.
    Williams S, Schepers A, Isaac G, Hardaker C, Ingham E, van der Jagt D, Breckon A, Fisher J. The 2007 Otto Aufranc award. Ceramic-on- metal hip arthroplasties: a comparative in vitro and in vivo study. Clin Orthop Relat Res. 2007;465:23–32.PubMedGoogle Scholar
  6. 6.
    Lusty PJ, Watson A, Tuke MA, Walter WL, Walter WK, Zicat B. Wear and acetabular component orientation in third generation alumina-on- alumina ceramic bearings: an analysis of 33 retrievals. J Bone Joint Surg Br. 2007;89(9):1158–64.CrossRefPubMedGoogle Scholar
  7. 7.
    Fisher J, Jin Z, Tipper J, Stone M, Ingham E. Tribology of alternative bearings. Clin Orthop Relat Res. 2006;453:25–34.CrossRefPubMedGoogle Scholar
  8. 8.
    Catelas I, Huk OL, Petit A, Zukor DJ, Marchand R, Yahia L. Flow cytometric analysis of macrophage response to ceramic and poly- ethylene particles: effects of size, concentration, and composition. J Biomed Mater Res. 1998;41(4):600–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Kubo T, Sawada K, Hirakawa K, Shimizu C, Takamatsu T, Hirasawa Y. Histiocyte reaction in rabbit femurs to UHMWPE, metal, and ceramic particles in different sizes. J Biomed Mater Res. 1999;45(4):363–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Petit A, Catelas I, Antoniou J, Zukor DJ, Huk OL. Differential apoptotic response of J774 macrophages to alumina and ultra-high-molecular-weight polyethylene particles. J Orthop Res. 2002;20:9–15.CrossRefPubMedGoogle Scholar
  11. 11.
    Catelas I, Petit A, Zukor DJ, Marchand R, Yahia L, Huk OL. Induction of macrophage apoptosis by ceramic and polyethylene particles in vitro. Biomaterials. 1999;20(7):625–30.CrossRefPubMedGoogle Scholar
  12. 12.
    Bohler M, Mochida Y, Bauer TW, Plenk H Jr, Salzer M. Wear debris from two different alumina-on-alumina total hip arthroplasties. J Bone Joint Surg Br. 2000;82:901–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Brown C, Williams S, Tipper JL, Fisher J, Ingham E. Characterisation of wear particles produced by metal on metal and ceramic on metal hip prostheses under standard and microseparation simulation. J Mater Sci Mater Med. 2007;18:819–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Fye MA, Huo MH, Zatorski LE, Keggi KJ. Total hip arthroplasty performed without cement in patients with femoral head osteonecrosis who are less than 50 years old. J Arthroplast. 1998;13:876–81.CrossRefGoogle Scholar
  15. 15.
    Gualtieri G, Nigrisoli M, Dallari D, Catamo L, Gualtieri I. A study of the mechanical and biological behavior of bioceramic hip arthroplasty followed-up after more than 10 years. Chir Organi Mov. 1993;78:213–22.PubMedGoogle Scholar
  16. 16.
    Huo MH, Martin RP, Zatorski LE, Keggi KJ. Ceramic total hip replacement done without cement. Long term follow-up study. Orthop Trans. 1995;19:400–1.Google Scholar
  17. 17.
    Hamadouche M, Boutin P, Daussange J, Bolander ME, Sedel L. Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study. J Bone Joint Surg Am. 2002;84-A:69–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Hernigou P, Zilber S, Filippini P, Poignard A. Ceramic ceramic bearing decreases osteolysis: a 20-year study versus ceramic-polyethylene on the contralateral hip. Clin Orthop Relat Res. 2009;467:2274–80.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Hatton A, Nevelos JE, Matthews JB, Fisher J, Ingham E. Effects of clinically relevant alumina ceramic wear particles on TNF-alpha production by human peripheral blood mononuclear phagocytes. Biomaterials. 2003;24:1193–204.CrossRefPubMedGoogle Scholar
  20. 20.
    Willmann G. Ceramic femoral head retrieval data. Clin Orthop Relat Res. 2000;379:22–8.CrossRefGoogle Scholar
  21. 21.
    Traina F, De Fine M, Bordini B, Toni A. Risk factors for ceramic liner fracture after total hip arthroplasty. Hip Int. 2012;22(06):607–14.CrossRefPubMedGoogle Scholar
  22. 22.
    Huet R, Sakona A, Kurtz SM. Strength and reliability of alumina ce- ramic femoral heads: review of design, testing, and retrieval analysis. J Mech Behav Biomed Mater. 2011;4(3):476–83.CrossRefPubMedGoogle Scholar
  23. 23.
    Szymanski C, Gueriot S, Boniface O, Deladerriere JY, Luneau S, Maynou C. Sandwich type ceramic liner fracture rate with the atlas III socket: a study of 144 primary total hip replacements at a mean 74 months’ follow-up. Orthop Traumatol Surg Res. 2011;97(5):494–500.CrossRefPubMedGoogle Scholar
  24. 24.
    Swanson TV, Peterson DJ, Seethala R, Bliss RL, Spellmon CA. Influence of prosthetic design on squeaking after ceramic-on-ceramic total hip arthroplasty. J Arthroplast. 2010;25(Suppl):36–42.CrossRefGoogle Scholar
  25. 25.
    Eichmann TH, Clarke IC, Gustafson GA. Squeaking in a ceramic on ceramic total hip. In: Lazannec JY, Dietrich M, editors. Bioceramics in joint arthroplasty. Germany: Steinkopff Verlag; 2004. p. 187–92.Google Scholar
  26. 26.
    Ecker TM, Robbins C, van Flandern G, et al. Squeaking in total hip replacement: no cause for concern. Orthopedics. 2008;31:875–6. 84CrossRefPubMedGoogle Scholar
  27. 27.
    Walter WL, Lusty PJ, Watson A, et al. Stripe wear and squeaking in ceramic Total hip bearings. Semin Arthroplast. 2006;17:190–5.CrossRefGoogle Scholar
  28. 28.
    Taylor S, Manley MT, Sutton K. The role of stripe wear in causing acoustic emissions from alumina ceramic-on-ceramic bearings. J Arthroplast. 2007;22(7 Suppl 3):47–51.CrossRefGoogle Scholar
  29. 29.
    Glaser D, Komistek RD, Cates HE, Mahfouz MR. Clicking and squeak- ing: in vivo correlation of sound and separation for different bearing surfaces. J Bone Joint Surg Am. 2008;90(Suppl 4):112–20.CrossRefPubMedGoogle Scholar
  30. 30.
    Chevillotte C, Trousdale RT, Chen Q, Guyen O, An KN. The 2009 frank Stinchfield award: “hip squeaking”: a biome- chanical study of ceramic-on-ceramic bearing surfaces. Clin Orthop Relat Res. 2010;468:345–50.CrossRefPubMedGoogle Scholar
  31. 31.
    Nevelos J, Ingham E, Doyle C, Streicher R, Nevelos A, Walter W, Fisher J. Microseparation of the centers of alumina-alumina artificial hip joints during simulator testing produces clinically relevant wear rates and patterns. J Arthroplast. 2000;15:793–5.CrossRefGoogle Scholar
  32. 32.
    Parvizi J, Adeli B, Wong JC, Restrepo C, Rothman RH. A squeaky reputation: the problem may be design-dependent. Clin Orthop Relat Res. 2011;469(6):1598–605.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Restrepo C, Post ZD, Kai B, Hozack WJ. The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty. J Bone Joint Surg Am. 2010;92(3):550–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Owen H. An estimation of the incidence of squeaking and revision surgery for squeaking in ceramic-on-ceramic total hip replacement a meta-analysis and report from the Australian d., orthopaedic association national joint registry. Bone Joint J. 2014;96-B:181–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Park YS, Park SJ, Lim SJ. Ten-year results after cementless THA with a sandwich-type alumina ceramic bearing. Orthopedics. 2010;33(11):796.PubMedGoogle Scholar
  36. 36.
    Sugano N, Takao M, Sakai T, Nishii T, Miki H, Ohzono K. Eleven- to 14-year follow-up results of cementless total hip arthroplasty using a third-generation alumina ceramic-on-ceramic bearing. J Arthroplast. 2012;27(5):736–41.CrossRefGoogle Scholar
  37. 37.
    Chevillotte C, Pibarot V, Carret JP, Bejui-Hugues J, Guyen O. Nine years follow-up of 100 ceramic-on-ceramic total hip arthroplasty. Int Orthop. 2011;35(11):1599–604.CrossRefPubMedGoogle Scholar
  38. 38.
    Jarrett CA, Ranawat AS, Bruzzone M, Blum YC, Rodriguez JA, Ranawat CS. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am. 2009;91(6):1344–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Stanat SJ, Capozzi JD. Squeaking in third- and fourth-generation ceramic-onceramic total hip arthroplasty: meta-analysis and systematic review. J Arthroplast. 2012;27:445–53.CrossRefGoogle Scholar
  40. 40.
    Stafford GH, Islam SU, Witt JD. Early to mid-term results of ceramic- on-ceramic total hip replacement: analysis of bearing-surface-related complications. J Bone Joint Surg Br. 2011;93(8):1017–20.CrossRefPubMedGoogle Scholar
  41. 41.
    Hannouche D, Delambre J, Zadegan F, Sedel L, Nizard R. Is there a risk in placing a ceramic head on a previously implanted trunion? Clin Orthop Relat Res. 2010;468(12):3322–7.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Iwakiri K, Iwaki H, Minoda Y, Ohashi H, Takaoka K. Alumina inlay failure in cemented polyethylene-backed total hip arthroplasty. Clin Orthop Relat Res. 2008;466(5):1186–92.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. Survival of hard-on-hard bearings in total hip arthroplasty: a sys- tematic review. Clin Orthop Relat Res. 2011;469(6):1536–46.CrossRefPubMedGoogle Scholar
  44. 44.
    Kress AM, Schmidt R, Holzwarth U, Forst R, Mueller LA. Excellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up. Int Orthop. 2011;35(2):195–200.CrossRefPubMedGoogle Scholar
  45. 45.
    Molloy D, Jack C, Esposito C, Walter WL. A mid-term analysis suggests ceramic on ceramic hip Arthroplasty is durable with minimal wear and low risk of squeak. HSS J. 2012;8:291–4.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Seo BH, Ryu DJ, Kang JS, Kyoung H. Primary total hip arthroplasty using 3rd generation ceramic-on-ceramic articulation moon. Hip Int. 2016;26(5):468–73.CrossRefPubMedGoogle Scholar
  47. 47.
    D'Antonio JA, Capello WN, Naughton M. Ceramic bearings for total hip arthroplasty have high survivorship at 10 years. Clin Orthop Relat Res. 2012;470(2):373–81.CrossRefPubMedGoogle Scholar
  48. 48.
    Boyer P, Huten D, Loriaut P, Lestrat V, Jeanrot C, Massin P. Is aluminaon-alumina ceramic bearings total hip replacement the right choice in patients younger than 50 years of age? A 7- to 15-year follow-up study. Orthop Traumatol Surg Res. 2010;96(6):616–22.CrossRefPubMedGoogle Scholar
  49. 49.
    Lee YK, Ha YC, Yoo JJ, Koo KH, Yoon KS, Kim HJ. Alumina-on-alumina total hip arthroplasty: a concise follow-up, at a minimum of ten years, of a previous report. J Bone Joint Surg Am. 2010;92(8):1715–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Si H-b, Zeng Y, Cao F, Pei F-x, Shen B. Is a ceramic-on-ceramic bearing really superior to ceramic-on-polyethylene for primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials. Hip Int. 2015;25(3):191–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Eustathios Kenanidis
    • 1
  • Panagiotis Kakoulidis
    • 1
  • Eleftherios Tsiridis
    • 2
    Email author
  1. 1.Academic Orthopaedic UnitAristotle University Medical SchoolThessalonikiGreece
  2. 2.Academic Orthopaedic UnitPapageorgiou General Hospital, Aristotle University Medical SchoolThessalonikiGreece

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