Metal–Metal versus Ceramic–Ceramic: How to Choose?

Longevity of total hip arthroplasty (THR) is of increasing concern to the surgeon faced with ever younger patient populations, increased life expectancy, and increased activity expectations. Highly cross-linked polyethylene appears to reduce wear by about 50% compared with conventional polyethylene; however, its long-term success in avoidance of osteolysis is as yet unproven. Thus, the surgeon faces the alternatives of ceramic-on-ceramic (CC) or metal-on-metal (MM). This review will examine the advantages and disadvantages of each wear couple and present a clinical algorithm and rationale to guide the surgeon in the selection of the bearing surface.