Ceramic on Ceramic
The history goes back some thirty years, mainly in France and Germany.
The ceramic coupling surface has superior wear resistance mainly due
to its remarkable smoothness and wetting qualities and therefore leads
as the best combination as far as the tribological properties are
concerned. The early design of Mittelmeir in Germany had a high rate
of failure due to the unsuitability of a direct ceramic to bone interface
between the cup and the acetabular bone. The cups had a tendency to
loosen and there were frequent breakages. However the modern designs
use a titanium shell in contact with bone and the advances in ceramic
technology have made breakages extremely rare.
Ceramic on ceramic cementless total hip replacement is today one of
the best options for active healthy biologically young patients. There
are however some technical limitations connected with the bony architecture
so that this method cannot be applied in all cases.
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