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The Journal of Bone and Joint Surgery (American) 83:S68-72 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Alternative Bearing Surfaces: The Good, the Bad, and the Ugly

A. Seth Greenwald, DPhil(Oxon) and Jonathan P. Garino, MD for the Committee on Biomedical Engineering and the Committee on Hip and Knee Arthritis

A. Seth Greenwald, DPhil(Oxon) Orthopaedic Research Laboratories, Lutheran Hospital, Cleveland Clinic Health System, 1730 West 25th Street, Cleveland, OH 44113. E-mail address: seth@orl-inc.com

Jonathan P. Garino, MD Department of Orthopaedic Surgery, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104-4303

Acknowledgments: David C. Ayers, MD, Joshua J. Jacobs, MD, Anastasia K. Skipor, MS, CeramTec AG, Sulzer Orthopedics, Limited, and Wright Medical Technology, Incorporated.

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The first 150 words of the full text of this article appear below.


   Introduction
 
This article discusses current bearing-surface alternatives for long-term total hip articulations involving metal-polyethylene, ceramic-polyethylene, metal-metal, and ceramic-ceramic couples.


   Metal-Polyethylene
 
The enduring success of the low-friction arthroplasty advanced by Sir John Charnley as a solution for painful hip problems can be appreciated by the fact that, in 1999, more than 270,000 hip arthroplasties were performed in the United States. Over the last three decades, patient profiles have changed substantially, resulting in demands for a greater service life of ultra-high molecular weight polyethylene hip components. Material failure, often leading to an osteolytic response, is increasingly associated with younger, more active patients. In this context, the low-friction solution has become a problem, limiting in vivo system longevity (Figs. 1 and 2).


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  		Fig. 1: A marked osteolytic response in a fifty-year-old patient.

 

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  		Fig. 2: Corresponding intracellular polyethylene debris viewed under polarized light.

 

   New Polys for Old?
 
Previous attempts to improve the performance of ultra-high molecular weight polyethylene have included carbon-fiber reinforcement . . . [Full Text of this Article]


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