Zirconia ball heads have been implanted successfully from the late 1980s, but reports of wear and fractures have raised concerns about this ceramic biomaterial. This paper reviews the literature on clinical wear of zirconia-polyethylene bearings, zirconia head degradation and fractures, analysing the different factors that have led to clinical failure, such as material source, manufacturing process and type of polyethylene. The results underline the need for more homogeneous clinical series. Careful follow-up of patients with zirconia-polyethylene bearings is recommended.
MasonisJ.L., BourneR.B., RiesM.D., McCaldenR.W., SalehiA., KelmanD.C.Zirconia femoral head fractures: a clinical and retrieval analysis.J Arthroplasty2004; 19: 898–905.
2.
RiegerW.Ceramics orthopedics - 30 years of evolution and experience. In: RiekerC., OberholzerS., WyssU., eds. World Tribology Forum in Arthroplasty.Bern: Hans Huber2001; 283–94.
3.
BianchiA.E., BosettiM., DolciGJr., SbernaM.T., SanfilippoS., CannasM.In vitro and in vivo follow-up of titanium transmucosal implants with a zirconia collar.Journal of Applied Biomaterials & Biomechanics2004; 2: 143–50.
CalandruccioJ.H., JobeM.T.Arthroplasty of the thumb carpometacarpal joint.Semin Arthroplasty1997; 82: 135–47.
6.
KakehashiY., LüthyH., NaefR., WohlwendA., SchärerP.A new all-ceramic post and core system: clinical, technical and in vitro results.Int J Periodontics Restorative Dent1998; 18: 587–93.
7.
KohalR.J., PapavasiliouG., KamposioraP., TripodakisA., StrubJ.R.Three-dimensional computerized stress analysis of commercially pure titanium and yttrium-partially stabilized zirconia implants.Int J Prosthodont2002; 15: 189–94.
8.
LuthardR.G., SandkulO., ReitzB.Zirconia-TZP and alumina: advanced technologies for the manufacture of single crowns.Eur J Prosthodont Restor Dent1999; 7: 113–9.
9.
NakamuraT., OonishiE., YasudaT., NakagawaY.A new knee prosthesis with bisurface femoral component made of zirconia-ceramic.Key Eng Mater2004; 254–6: 607–10.
10.
SmithH.E., WimberleyD.W., VaccaroA.R.Cervical arthroplasty: material properties.Neurosurg Focus2004; 17: E3.
11.
WeberW., RiegerW.ZrO2-TZP in dentistry. Material, properties and applications.Key Eng Mater2000; 192–5: 841–4.
12.
Ministére de l'emploi et de la solidarité.Décision du 10 aôut 2001 portant sur la suspension d'utilisation de certaines tetées de prothése de hanche en céramique de zircone.Journal Officiel de la République Française, Textes Generaux2001; 200: 13884.
13.
International Standards Organisation.TC150 Implants for Surgery - ISO 13356: Ceramic materials based on yttria-stabilized tetragonal zirconia (Y-TZP); 1997.
14.
American Society for Testing and Materials.ASTM F-1873: Standard specification for high-purity dense yttria tetragonal zirconium oxide polycrystal (Y-TZP) for surgical implant applications.ASTM International1998.
15.
American Society for Testing and Materials.ASTM F-2393: Standard specification for high-purity dense magnesia partially stabilised zirconia (Mg-PSZ) for surgical implant applications.ASTM International2004.
16.
PiconiC., MaccauroG.Zirconia as a ceramic biomaterial.Biomaterials1999; 20: 1–25.
17.
HanninkR.H., KellyP.M., MuddleB.C.Transformation toughening in zirconia-containing ceramics.J Am Ceram Soc2000; 83: 461–87.
18.
SatoT., ShimadaM.Transformation of yttria-doped tetragonal ZrO2 polycrystals by annealing in water.Journal of the American Ceramic Society1985; 68: 356–9.
19.
YoshimuraM., NomaT., KawabataK., SomiyaS.Role of H2O on the degradation process of Y-TZP.J Mater Sci Lett1987; 6: 465.
20.
SwabJ.J.Low temperature degradation of Y-TZP materials.J Mater Sci Mater Med1991; 26: 6706–14.
21.
ShimizuK., OkaM., KumarP.. Time dependent changes in the mechanical properties of zirconia ceramics.J Biomed Mater Res1993; 27: 729–34.
22.
CalésB.Y-TZP zirconia ceramic hip joint heads: key issues for a high reliability. In: RavaglioliA., ed. Fourth Euro-Ceramics - Vol. 8 Bioceramics. Faenza: Faenza Editrice1995; 45–52.
TsubakinoH., NozatoR., HamamotoM.Effect of alumina addition on the tetragonal-to-monoclinic phase transformation in zirconia-3 mol% yttria.Journal of the American Ceramic Society1991; 74: 440–3.
25.
RossI.M., RainforthW.M., McCombD.W., ScottA.J., BrydsonR.The role of trace addition of alumina to yttria-tetragonal zirconia polycrystals (Y-TZP).Scripta Materialia2001; 45: 653–60.
26.
LepistöT.T., MäntylaT.A.Degradation of TZP ceramics in humid atmosphere. In: ClarkD.E., ZoitosB.K., eds. Corrosion of glass, ceramics and ceramics superconductors.Park Ridge: Noyes1992; 492–513.
27.
HiranoM.Inhibition of low temperature degradation of tetragonal zirconia ceramics - a review.Transactions and Journal of the British Ceramic Society1992; 91: 139–47.
28.
LawsonS.Environmental degradation of zirconia ceramics.Journal of the European Ceramic Society1995; 15: 485–502.
29.
JennyJ.Y., BoeriC., TavanA., SchlemmerB.Résultats en fonction de la couple de frottement.Rev Chir Orthop Reparatrice Appar Mot1998; 84(suppl 1): 111–2.
30.
AllainJ., Le MouelS., GoutaillierD., VoisinM.C.Poor eight-years survival of cemented zirconia-polyethylene total hip replacements.J Bone Joint Surg Br1999; 81: 835–42.
31.
DambrevilleA., PhilippeM., RayA.La céramique de zircone.Mâitrise Orthopédique1999; 78: 1–11.
32.
PauleR., DambrevilleA., GaconG., PhilippeM., RayA.Zirconia hip joint heads: wear of polyethylene. Presented at the 6th World Biomaterials Conference - Workshop 7. Honolulu, May 2000.
33.
KimY.H., KimJ.S., ChoS.H.A comparison of polyethylene wear in hips with cobalt-chrome or zirconia heads.J Bone Joint Surg Br2001; 83: 742–50.
34.
NortonM.R., YarlagaddaR., AndersonG.H.Catastrophic failure of Elite Plus total hip replacement with Hylamer acetabulum and zirconia ceramic femoral head.J Bone Joint Surg Br2002; 84: 631–5.
35.
HernigouP., BahramiT.Zirconia and alumina ceramics in comparison with stainless steel heads.J Bone Joint Surg Br2003; 85: 504–9.
36.
WroblewskiB.M., SineyP.D., FlemingP.A.Wear of enhanced ultra-high molecular weight polyethylene (Hylamer) in combination with a 22.225 mm diameter zirconia femoral head.J Bone Joint Surg Br2003; 85: 376–9.
37.
WroblewskiB.M., SineyP.D., NagaiH., FlemingP.A.Wear of ultra-high-molecular-weight polyethylene cup articulating with 22.225 mm zirconia diameter head in cemented total hip arthroplasty.J Orthop Sci2004; 9: 253–5.
38.
HerreraA., CanalesV., AndersonJ., Garcia-AraujoC., Murcia-MazonA., ToninoA.J.Seven to ten years followup of an anatomic hip prosthesis.Clin Orthop Relat Res2004; 423: 129–37.
39.
SkyrmeA.D., RichardsS., JohnA., ChiaM., WaltherW.K., ZicatB.Polyethylene wear rates with zirconia and cobalt chrome heads in the ABG hip.Hip International2005; 15: 63–70.
40.
KielyP.D., HartyJ.A., McElwainJ.P.Hylamer wear rates and shelf life: A clinical correlation.Acta Orthop Belg2005; 71: 429–34.
41.
KimY.O.Comparison of polyethylene wear associated with cobalt-chromium and zirconia heads after total hip replacement.J Bone Joint Surg Am2005; 87: 1769–76.
42.
HaraguchiK., SuganoN., NishiiT., MikiH., OkaK., YoshikawaH.Phase transformation of a zirconia ceramic head after total hip arthroplasty.J Bone Joint Surg Br2001; 83: 996–1000.
43.
NakamuraT., TanakaK., TamuraJ.. Clinical and laboratory wear studies of zirconia-on-UHMWPE combination in cementless THA.Key Eng Mater2005; 240–2: 823–6.
44.
LiangB., KawanabeK., IseK., ShimizuM., IidaH., NakamuraT.Polyethylene wear against alumina and zirconia heads in K-MAX total hip arthroplasy.Key Eng Mater2005: 284–6: 971–4.
45.
von SchewelovT., SanzenI., ÖnstenI., KarlssonÅ, BesjakovJ.Total hip replacement with a zirconium oxide ceramic femoral head.J Bone Joint Surg Br2005; 87: 1631–5.
46.
CatonJ.H.THR Charnley type with Zr/PE bearing results of more than 5 years FU. In: BenazzoF., FalezF., DietrichM., eds. Bioceramics and alternative bearings in joint arthroplasty.Darmstadt: Steinkopff2006; 293–4.
47.
ArnaudJ.P., CosteC., CharissouxJ.L., MabitC., PecoutC.Céramiques et couples de frottement dans les rothèses totales de hanche.Annales Orthopédiques de l'Ouest2005; 37: 25–32.
48.
DietrichA., HeimannR.B., WillmannG.The colour of medical grade zirconia (Y-TZP).J Mater Sci Mater Med1996; 7: 559–65.
49.
CalésB., StefaniY.Yttria-stabilised zirconia for improved orthopedic prostheses. In: WiseD.L., TrantoloD.J., AltobelliD.E., eds. Encyclopedic Handbook of Biomaterials and Bioengineering.New York: Marcel Dekker1995; 415–52.
50.
VisentinM., SteaS., De ClericoM.. Determination of crystallinity and crystal structure of Hylamer polyethylene after in vivo wear.J Biomater Appl2006; 21: 131–45.
51.
SantosE.M., VohraS., CatledgeS.A., McClennyM.D., LemonsJ., MooreK.D.Examination of surface and material properties of explanted zirconia femoral heads.J Arthroplasty2004; 19(suppl 2): 30–4.
52.
ClarkeI.C., ManakaM., GreenD.. Current status of zirconia used in total hip implants.J Bone Joint Surg Am2003; 85(suppl 4): 73–84.
53.
StewartT., FlemmingN., WroblewskiB.M., FisherJ.The stability and durability of zirconia femoral heads. Proceedings of the 51st Orthopaedic Research Society Meeting. Washington DC, February 2005; 1167.
54.
CatonJ., BouralyJ.P., ReynaudP., MerabetZ.Phase transformation of zircone heads after total hip arthroplasty: myth or reality?J Bone Joint Surg Br2004; 87(suppl 2): 120.
55.
ChevalierJ.What future for zirconia as a biomaterial?Biomaterials2006; 27: 535–43.
56.
HummerC.D., RothmanR.H., HozackW.J.Catastrophic failure of modular zirconia ceramic femoral head components after total hip arthroplasty.J Arthroplasty1995; 10: 848–50.
57.
ArnaudJ.P., CharissouxJ.L., SettonD., PecoutC., MechinJ.F., DunoyerJ.Utilisation de la zircone pour les têtes de 22,22 mm de prothèses totales de hanche: a pròpos de 10 fractures de têtes. Presented at the 30é Meeting de la Societé Othopédique de l'Ouest. Pont l'Aubée, France: June 1997.
58.
CalésB.Fractures des têtes de prothèses de hanche en zircone.Mâitrise Orthopédique2000; 96: 26–30.
59.
OonishiH., AminoH., UenoM., YunokiH.Concept and design with ceramics for total hip and knee replacement. In: SedelL., WillmannG., eds. Reliability and long-term results of ceramics in orthopaedics.Stuttgart: Thieme1999; 7–28.
60.
UenoM., AminoH., NishidaM., MasudaS., ShimitosoT.Experience on zirconia femoral heads in Japan. Presented at the 6th World Biomaterials Conference - Workshop 7. Honolulu, May 2000.
61.
CatonJ., BouralyJ.P., CalésB.Zirconia-UHMWPE articulation using 22,2 mm dia. femoral heads. Proceedings of the International Symposium Charley 2000. Lyon, December 2000; 107–9.
62.
BanonF.Experience with ceramic heads and friction with polyethylene or alumina cups in hip surgery. A new couple zirconia-alumina. About 163 cases. Presented at the 6th World Biomaterials Conference - Workshop 7. Honolulu, May 2000.
Johnson-WallsD., EvansA.G., MarshallD.B., JamesM.R.Residual stresses in machined ceramic surfaces.Journal of the American Ceramic Society1986; 69: 44–7.
65.
LuthardR.G., HolzüterM., SandkulO.. Reliability and properties of ground Y-TZP zirconia ceramics.J Dent Res2002; 81: 487–91.
66.
KosmacT., OblakC., JanvikarP., FundukN., MarionL.Strength and reliability of surface treated Y-TZP dental ceramics.J Biomed Mater Res B Appl Biomater2000; 53: 304–13.
67.
GuazzatoM., QuachL., AlbakoyM., SwainM.V.Influence of surface and heath treatment on the flexural strength of Y-TZP dental ceramics.J Dent2005; 33: 9–18.
68.
BlaiseL., VillermauxF., CalésB.Ageing of zirconia: everything you always wanted to know.Key Eng Mater2001; 192–5: 553–6.
69.
GrantK.L., RawlingsR.D., SweeneyR.Effect of HIPping, stress and surface finish on the environmental degradation of Y-TZP ceramics.J Mater Sci Mater Med2001; 12: 557–64.
70.
Medical Devices Agency. MDA Safety Notice SN9617 - Zirconia ceramic heads for modular total hip femoral components: advice to users on resterilization. June 1996.
71.
ScottD.L., CampbellP.A., McClungC.D., SchmalzriedT.P.Factors contributing to rapid wear and osteolysis in hip with modular acetabular bearings made of Hylamer.J Arthroplasty2000; 15: 35–46.
72.
DumbletonJ.H., ManleyM.T., EdiddinA.A.A literature review of the association between wear rate and osteolysis in total hip arthroplasty.J Arthroplasty2002; 17: 649–61.
73.
HerbertsP., KärrholmJ., GarellikG.The Swedish Arthroplasty Register, Annual Report 2004 (http://www.jru.orthop.gu.se); May 2005.
74.
MaccauroG., PiconiC., BurgerW.. Fracture of a Y-TZP ceramic femoral head. Analysis of a fault.J Bone Joint Surg Br2004; 86: 1192–6.
75.
CalésB.Fractures des têtes de prothèses de hanche en zircone - le point de vue du fabricant. Presented at 4é Jounées d'Orthopedie P Teinturier. Clermont-Ferrand, October 2002.