Ceramics in THR Bearings: Behavior under Off-Normal Conditions

The use of ceramics bearings in total hip joint replacement (THR) has increased markedly in the last ten years thanks to the optimum wear behaviour of ceramic-on-ceramic bearings and of the high biological safety of ceramic wear debris. As the number of ceramic THR bearings is increasing, also the number of implants that experience off-normal working conditions, e.g. edge loading, third bodies in the joint, soft tissues laxity, dislocation/subluxation of the joint, increases. Under all such conditions the surface of the bearing can be damaged to variable extent, leading eventually to a limitation of the expected performances of the implant.