Ceramic-On-Ceramic Bearings: For the Hard of Hearing and Living Alone—Affirms

Historically, ceramic-on-ceramic bearings have had an excellent global clinical track record, with only very rare reports of audible squeaking. Recently, however, this squeaking phenomenon has been reported with increasing frequency, and in particular with the most commonly used design in North America that being a titanium metal-backed ceramic insert with an elevated titanium rim. The definitive etiologic background of this new problem remains elusive and will most certainly be multifactorial. Issues of particulate debris, joint fluid lubrication, and even femoral component design and metallurgy may all play an important causative role. It is critical, however, to understand and identify the issues surrounding any noted bearing-related complication and to understand the related factors, rather than simplistically vilifying an entire bearing class, as is so often done. Squeaking ceramic-on-ceramic bearings is a classic example of this issue. To move forward the science of alternate bearings in total hip arthroplasty, we have to look at all the issues involved with any given bearing, not minimizing any complication, while at the same time not simplifying the issues to the point where we no longer apply critical thinking to the published data and simply abandon an entire bearing class at the first sign of any reported concern.

Keywords: total hip arthroplasty, ceramic-on-ceramic, squeaking