Alumina-on-Alumina Bearings in Hip Arthroplasty: What Every Surgeon Should Know

Abstract

The history of alumina-alumina (Al-Al) bearing surfaces for total hip arthroplasty started in France with Boutin et al. (1988) who implanted the first alumina hip in 1970. Alumina heads are used because of their wear characteristics (Jazrawi et al. 1999) and because of their superior smoothness. In the earliest designs, a bulk alumina acetabular component was implanted either with cement by Boutin et al. (1988) or as a press fit by Mittelmeier and Heisel (1992). Fixation proved to be insufficient (Hamadouche et al. 1999, 2002), and at the beginning the predominant cause of failure was aseptic loosening. Another complication was alumina fracture (Fritsch and Gleitz 1996), and for many surgeons, revision procedure was noted difficult when fracture of alumina ceramic head occurs. The success of contemporary Al-Al bearings (Capello et al. 2008; Chevillotte et al. 2011; Garino 2000; Kim et al. 2010; Mesko et al. 2011) is due both to the absence of osteolysis (Bascarevic et al. 2010; Hernigou and Bahramy 2003; Hernigou et al. 2009) demonstrated in studies with long-term follow-up and to the failures of metal-on-metal friction (Medicines and Healthcare products Regulatory Agency (MHRA) 2012). The aim of this chapter is to explain some clinical and engineering characteristics of Al-Al hips that are specific to this arthroplasty.