Ceramic Biomaterials: What are their Biological Implications?

Total Joint Arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis. In 2019 there were 95,677 primary total hip arthroplasty (THA) procedures performed in England, Wales and Northern Ireland and this is set to increase with our ageing population and rising obesity. As implants used in THA last on average 79.9% at 20 years, many patients require revision surgery which is associated with increased risks of infection, venous thromboembolism and mortality. Ceramics have become an increasingly popular implant bearing surface and their use has been increasing annually since 2008, with ceramic-on-polyethylene implants accounting for 37.8% of all primary THA performed in England, Wales and Northern Ireland. This is due to their reported properties of high wear resistance rate and being biologically inert. This brief review will cover examples of reported mechanical failure leading to component fracture, wear and audible hip squeaking in patients with ceramic implants. The ceramic wear debris in turn can stimulate a host inflammatory response, leading to osteolysis, aseptic loosening and pseudotumour formation. As ceramic use in hip arthroplasty increases, further understanding of the mechanical and biological mechanisms driving implant failure is required to improve implant longevity for patients and reduce revision surgery rates