Evidence brief
Alumina-on-Alumina Total Hip Replacement: A Five to Eighteen Year Prospective Study
Ceramic-on-ceramic provides excellent wear characteristics
Wear rates 0.001-0.05 mm/year (vs 0.1-0.2mm for MoP)
Concerns: fracture risk (modern ceramics <0.01%), squeaking (1-5%)
Evolution from alumina to alumina matrix composites (BIOLOX delta)
No osteolysis from ceramic wear debris
Ceramic bearings offer the lowest wear rates and are particularly suitable for young, active patients. Modern ceramic composites have addressed early concerns about fracture.
Know ceramic evolution: pure alumina (3rd gen) → alumina matrix composite (4th gen, BIOLOX delta). Advantages: lowest wear, biologically inert debris. Disadvantages: fracture risk (reduced in modern ceramics), squeaking, stripe wear with edge loading. Never use with titanium modular sleeves.
Bizot P et al. Alumina-on-alumina total hip replacement: a five to eighteen year prospective study. J Bone Joint Surg Br. 2000;82(7):1043-1048.
Level III
Retrospective comparative study or case-control study