Ceramic-on-ceramic total hip replacement uses alumina or composite ceramic bearings for both the femoral head and the acetabular liner. It provides the lowest wear rate of any bearing combination and is particularly suited for younger, more active patients.
The surgical procedure is identical to standard total hip replacement. The difference is the bearing surface: a ceramic femoral head articulates against a ceramic acetabular liner instead of the more common ceramic-on-polyethylene combination. Modern fourth-generation ceramics (delta ceramics) are alumina-matrix composites with very low fracture risk. The operation takes one to one and a half hours.
Ceramic-on-ceramic bearings are considered for younger patients (under 55–60), active patients with high wear demands, patients with metal sensitivity, and those who wish to minimise bearing-related complications over a long lifespan.
All standard non-operative hip arthritis treatments. Other bearing options: ceramic-on-polyethylene (most common), metal-on-polyethylene, and ceramic-on-crosslinked polyethylene.
Standard THR pre-assessment. Discussion of bearing options including the specific characteristics of ceramic bearings.
The lowest volumetric wear rate of any bearing combination. Excellent biocompatibility — no metal ion concerns. Potential for the longest implant survival, making it attractive for younger patients who need their hip to last decades.
Audible squeaking during certain movements. Occurs in approximately 1–10% of patients. Usually intermittent and tolerable.
Dislocation, infection, blood clots, leg length discrepancy.
Modern delta ceramics have a fracture risk of approximately 1 in 10,000. If the ceramic breaks, emergency revision is needed to remove ceramic fragments.
If the hip subluxes (edge-loading), a stripe of wear may develop on the ceramic head.
The ceramic liner may chip if it impinges against the metal shell or the femoral neck.
If revision is needed, ceramic-on-ceramic cannot be revised to metal-on-polyethylene (retained ceramic fragments may cause catastrophic wear of a metal head). Must be revised to ceramic.
Same as standard THR — general or spinal anaesthesia.
Identical to standard THR. Hospital one to three days. Walking from day one. Driving at six weeks. Full recovery six to twelve months.
Same as standard THR: X-rays at six weeks, one year, then every two to five years.
Squeaking is usually intermittent, occurs with specific movements, and is tolerable. It does not indicate implant failure. If persistent and troublesome, it can be addressed with revision surgery, but this is rarely needed.
Ceramic fracture is very rare with modern ceramics (approximately 1 in 10,000). If it occurs, urgent revision is needed to remove ceramic debris. The hip must be revised to another ceramic bearing — not metal — because retained microscopic ceramic particles would destroy a metal head.
Ceramic-on-ceramic has the lowest wear rate but carries the small risk of fracture and squeaking. Ceramic-on-highly-crosslinked-polyethylene has extremely low wear rates with no fracture risk and is the most commonly used bearing combination worldwide. Both are excellent choices — the decision depends on patient age, activity level, and preference.