I'm going to have my left hip replaced in a couple of months. I'm only 54-years-old, so I want to go with an implant that will last as long as possible. What do you think of the ceramic type?
Ceramic-on-ceramic bearings have always shown good wear with low incidence of debris. Debris refers to tiny flakes of material chipped off the implant. The debris falls back into the joint causing an inflammatory reaction.
In general, ceramic implants wear well with few problems. Early on, there were cases of ceramic fracture. But over time, these have been reduced considerably. In the past 20 to 30 years, the implant manufacturers have designed a better implant and improved ways of making them.
Even so, in the last few years, there have been increasing reports of problems with squeaking or grinding with the ceramic implants. Efforts to get to the bottom of this complication have led surgeons to believe it may be linked with the type of components used.
The fact that the squeaking started at a specific time period points to the time when surgeons started combining the ceramic-on-ceramic bearings with any of the femoral components available (conventional titanium stem, beta titanium stem, thinner stem). So for example, hip implants could include a ceramic liner but a titanium stem. And the titanium could be a pure (conventional) or mixed (beta) alloy.
The results of a recently published study suggest that impingement caused by a beta titanium femoral component (compared to conventional titanium alloy) bumping up against the titanium rim of the hip socket shell creates problems with the alumina ceramic bearings.
Flush-mounted liners with conventional titanium femoral stems did not cause squeaking. Flush-mounted means that the edges of the shell and the liner are even with each other. The problem wasn't with the ceramic bearings as much as it was the materials around the bearings. A recessed liner with a beta titanium alloy combined together seemed to cause the most problems. With the recessed liner, the edge is not even with the shell. Instead, the edge of the liner is slightly below the rim of the shell.
What we don't know is the type of debris (e.g., molybdenum, zirconium, iron) put out by beta titanium. Maybe some types of wear debris cause more problems than others. Future studies are needed to improve the materials and the design of hip implants, especially the ceramic ones that can cause squeaking when used with titanium alloy stems.
Talk to your surgeon about what option is best for you. Age, general health, activity level, and type of implants available are all considerations when planning this type of surgery.
T. M. Ecker, MD, et al. Squeaking in Total Hip Replacement: No Cause for Concern. In Orthopedics. September 2008. Vol. 31. No. 9. Pp. 875-876, 884.
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