Alternative bearing surface in total hip arthroplasty

Purpose of review: Today's orthopedic surgeon has many options to choose from when performing total hip arthroplasty (THA), including the type of bearing surface. Controversies exist with regard to which bearing coupling is superior. This review presents recent data on the wear characteristics, osteolysis, and complications associated with hard-on-hard bearing surfaces. Recent findings: Age and activity level are among the most important predictors of wear after THA. The introduction of highly cross-linked polyethylene has improved wear debris generation in the short term. Despite this improvement, wear and osteolysis resulting in failure of the THA remain significant concerns, particularly in young and active patients. Hard-on-hard articulation is an accepted alternative to metal-on-polyethylene coupling. Recent studies have shown decreased wear and loosening with hard-on-hard articulations. Potential systemic effects of disseminated metallic wear debris and ceramic fracture are major limitations of this type of coupling in THA. Summary: Recent publications support improved wear rates and decreased osteolysis with the use of hard-on-hard articulations. These data lend support to the use of hard-on-hard coupling in young and active patients, who have the highest risk for accelerated wear of their THAs.