The use of dense alumina–alumina ceramic combination in total hip replacement

Abstract

The purpose of this article was to review the laboratory and clinical performances since 1970 of a total hip prosthesis using alumina-alumina combination. The chemical and physical properties of dense alumina ceramic were studied in relation to biocompatibility, mechanical strength, and surface properties. Through the examination of 35 retrieved implants, it was found that the long-term success of alumina-alumina total hip replacement depends on both the ceramic microstructure (small grain size with uniform distribution, minimum porosity, absence of inclusions) and implant geometry (sphericity deviation +/- 1 micron, radius tolerance between components 7-10 microns). Alumina component wear and fractures have disappeared with the use of high-performance materials and severe manufacturing quality control. Examination of human biopsies from well-fixed prostheses showed that alumina particles deposits increase with time with only a low-grade macrophagic reaction. When loosening occurred, an inflammatory reaction appeared; this reaction was less striking than with loose metal-polyethylene prostheses, however. The long-term behavior of cementless alumina cup fixation depends upon initial positioning and stability; survivorship analysis of the cemented ceramic cups showed an 88% survival probability after 8 years with a 1.6% average annual probability of revision. The percentage of surviving was 100% after 8 years in patients who were less than 50 years old. Aseptic loosenings occurring at the cup-cement interface were assumed to be related to stress protection secondary to the high rigidity of the ceramic leading to a weakening of the spongious bone supporting the cement mantle. Good bone stock quality as well as high-quality ceramic appear to be the prerequisites for durable fixation of alumina sockets.

History and Systematic Review of Wear and Osteolysis Outcomes for First-generation Highly Crosslinked Polyethylene

“…Orthopaedic bearing designs incorporating gamma-airsterilized polyethylene proved to be more robust and reliable than other early alternatives, including first-generation metal-on-metal of the 1960s [4,94,120] and ceramic-onceramic bearings of the 1970s [17]. Difficulty in controlling the tolerances of early metal-on-metal hips has been hypothesized to result in seizure of some metal bearings culminating in early loosening [72], whereas first-generation alumina components were prone to unacceptably high fracture rates [141].…”

Mechanical performance of ceramic acetabular liners under impact conditions

“…Alumina ceramic (Al 2 O 3 ) is a hydrophilic, low friction, thermodynamically and chemically stable material [1]. Medical grade alumina for joint replacements has a smooth surface finish [2] and, when implanted as the articulating surfaces of a total hip replacement, generally exhibits reduced wear rates compared to more traditional metal-on-plastic bearing materials [3,4].…”

Biocompatibility and Bone Tissue Compatibility of Alumina Ceramics Reinforced with Carbon Nanotubes

“…A variety of ceramic products have been clinically applied as biomaterials, and their advantages include high biocompatibility, in vivo stability, and superior mechanical characteristics compared to biomaterials such as synthetic polymers, resins, and metals [1][2][3][4][5][6][7][8][9][10][11][12][13]. Alumina ceramics are particularly effective as biomaterials owing to their high strength, resistance to wear, and smooth surface [6][7][8].…”