Ceramic cups for hip endoprostheses. 5: Consideration of designs]

Using the combination ceramic on ceramic for hip prostheses, the wear rate can be reduced to less than 1 micron per million cycles. More than 20 years of experience are now available for various concepts involving alumina ceramics in THR. In the early days, monolithic ceramic cups were employed. However, since alumina ceramic has an unsatisfactory potential for bone integration, soft tissue forms at the interface, with the result that the sockets migrate and penetrate. To improve bony integration, monoblock cups surfaced with ceramic beads were introduced. For the past 10 years, there has been a trend towards the use of modular acetabular components comprising a metal shell and a liner made of Biolox forte ceramic. Two concepts for the fixation of the ceramic liners are employed: locking of the ceramic in the metal shell (CeraLock) and the sandwich concept with a polyethylene layer interposed between liner and shell. The basic design and important aspects such as diameter, range of motion, and the possibility for revision, clinical experience, and trends are discussed.