Total hip arthroplasty is an effective treatment option for advanced hip arthritis in elderly patients. Studies in young patients have traditionally shown less durable results. With current implants, surgical technique, and cementless fixation methods, the durability of total hip arthroplasty may now be related to the wear performance of the bearing surfaces. To improve implant longevity, there are several bearing surface choices currently available for this demanding group of patients. Alternatives must be evaluated in terms of the risks and benefits associated with each articulation, and all new technologies must be carefully monitored over the long term.
Key points
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With modern implants, surgical technique, and cementless fixation methods, the durability of total hip arthroplasty may now be related to the wear properties of the bearing surfaces.
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Alternative bearing surfaces may offer a solution to the wear-associated problems that have limited traditional total hip articulations.
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Bearing alternatives to traditional metal-on-polyethylene couples include metal/ceramic on highly cross-linked polyethylene, ceramic on ceramic, metal on metal, and ceramic on metal.
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Articulation choice must be evaluated in terms of the advantages and disadvantages (risks) associated with each bearing couple.
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Metal-on-metal bearings must be used with caution given the evolving understanding of local adverse responses to metal particulate debris.
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Further study in large cohorts of patients with greater follow-up will clarify the usefulness and durability of alternative bearings in total hip arthroplasty in young patients.
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