Ceramic Materials in Total Joint Arthroplasty

Bearing surfaces made of ceramic materials are an alternative to metal-on-polyethylene (PE) articulations in total hip arthroplasty and total knee arthroplasty. The advantage of ceramic surfaces in total joints is the reduction in wear rates compared with metal-on-PE. Lower wear rates result in a decreased volume of wear particles produced by the articulating surfaces. In theory, this should reduce the risk of periprosthetic osteolysis and premature implant loosening, thereby contributing to the longevity of prosthetic joints. In addition to ceramics, other alternative bearings, such as highly cross-linked PE and metal-on-metal, also offer decreased wear rates when compared with metal-on-PE articulations in total joint arthroplasty. Alumina and zirconia ceramics are familiar to orthopedic surgeons because both materials have a long history of use in total joint bearings. Alumina-on-alumina ceramic total hip articulations are now available in the United States from several implant manufacturers. Composite materials made by combining alumina and zirconia, metal-on-ceramic articulations, and new ceramic materials will offer even more choices as the search for the ideal bearing combination in total joint arthroplasty continues. The purpose of this article is to review the material properties, clinical applications, evolution, and limitations of the ceramic materials used in total joint bearings.