In vivo and in vitro outcomes of alumina, zirconia and their composited ceramic-on-ceramic hip joints

Abstract

Despite of brittleness, Ceramic-on-Ceramic (CoC) hip joints are appealing to arthritic patients because of its low friction rate, high wear resistance and low risk of osteolysis. The objectives of the study were to review and summarize the performance of Alumina, Zirconia and their functional graded material (FGM) for artificial hip joints in vivo and vitro outcomes. The Method of the study was scoping review which focused on the peer reviewed journals containing with alumina, zirconia and alumina zirconia FGM to CoC hip prosthesis. Advanced version of Alumina CoC was found to have excellent hardness but low fracture toughness. Alumina CoC hip joints was found to have a revision rate as high as 5% after 20 clinical outcomes. Zirconia ceramic had high fracture toughness but relatively low hardness when compared to Alumina ceramic. Alumina-Zirconia FGM consists both high hardness (outer surface) and improved fracture toughness (inner core) which led to better mechanical and tribological properties. However, to date, there is still no literature was found to have long period of clinical outcomes. No article was screened carrying out durability study of Alumina/Zirconia FGM for CoC hip joints with appropriate tribological experiment. Alumina/ Zirconia FGM could be very effective for long term durability of CoC hip joints. Nevertheless, this FGM needs to be investigated under appropriate tribological tests considering dynamic loadings, dimension and shape of the joints, lubricant similar to synovial fluid and large number of cycles. The long term clinical outcomes also need to be published to increase its acceptability to young active patients.

The impact of surface and geometry on coefficient of friction of artificial hip joints

“…According to the 2014 Canadian Joint Replacement Registry, the numbers of hip and knee replacements have increased by 16.5% and 21.5%, respectively, over the last five years 3 . The demographics include an increasing number of younger patients (45-64 years) and thus, prostheses are now required to last over 30 years [3][4][5] .…”

Alumina Ceramic Exacerbates the Inflammatory Disease by Activation of Macrophages and T Cells

“…It has been shown that the Al 2 O 3 induces the activation of human macrophages [ 2 , 3 , 40 ]. In addition, we further found that the systemic injection of Al 2 O 3 FPs promoted the activation of macrophages, Th1, and Tc1 cells, leading to exacerbation of the inflammatory diseases such as colitis.…”

“…Alumina ceramic articulation, made of aluminum oxide (Al 2 O 3 ), is one of the bearing surfaces of hip arthroplasty, which is well known to have high resistance to wear and high chemical stability [ 1 , 2 , 3 ]. For these reasons, alumina ceramic articulation has been used for several decades.…”

“…Joints perform tens of thousands of frictional movements in their lifetime [ 4 ]. Although the wear rate of alumina ceramic has been shown to be less than 1 μm/year, the fine particles (FPs) of Al 2 O 3 are generated by continuous frictional movement, which may promote inflammation in the adjacent tissue of implant [ 2 , 3 , 5 , 6 ]. Previous studies have shown that the treatment of Al 2 O 3 FPs induced activation of human macrophages, which produced higher levels of tumor necrosis factor-α (TNF-α) [ 7 , 8 , 9 , 10 ].…”

Effect of Geometrical Parameters on the Performance of Longitudinal Functionally Graded Femoral Prostheses

“…Total hip replacement (THR) is a surgical approach that can successfully relieve pain and restore hip joint function . Advances in technology help prosthesis designers and surgeons customize implants and prolong the lifespan of THR .…”