Recent updates for biomaterials used in total hip arthroplasty

Abstract

Background: Total hip arthroplasty (THA) is probably one of the most successful surgical interventions performed in medicine. Through the revolution of hip arthroplasty by principles of low friction arthroplasty was introduced by Sir John Charnley in 1960s. Thereafter, new bearing materials, fixation methods, and new designs has been improved. The main concern regarding failure of THA has been the biological response to particulate polyethylene debris generated by conventional metal on polyethylene bearing surfaces leading to osteolysis and aseptic loosening of the prosthesis. To resolve these problems, the materials of the modern THA were developed since then.

Methods: A literature search strategy was conducted using various search terms in PUBMED. The highest quality articles that met the inclusion criteria and best answered the topics of focus of this review were selected. Key search terms included 'total hip arthroplasty', 'biomaterials', 'stainless steel', 'cobalt-chromium', 'titanium', 'polyethylene', and 'ceramic'.

Results: The initial search retrieved 6921 articles. Thirty-two articles were selected and used in the review.

Conclusion: This article introduces biomaterials used in THA and discusses various bearing materials in currentclinical use in THA as well as the newer biomaterials which may even further decrease wear and improve THA survivorship.

Keywords: Arthroplasty; Biomaterials; Ceramic; Cobalt-chromium alloy; Hip; Polyethylene; Stainless steel; Titanium alloy.

Fig. 1

Early bearing materials used in THA (a) MoM Mckee-Farrer THA from 1960 (b) MoP combinations, Thompson prosthesis in a 1960s (c) CoC hip implants in a 1970s (d) CoP combinations over 1963–1973

Fig. 2

Recent bearing materials used in THA (a) MoP bearing (b) Large head MoM bearing (c) Small head MoM bearing (d) CoC articulation (e) CoP articulation

Fig. 3

A 62-year-old male patient with right total hip arthroplasty using MoP bearing (a) Radiograph illustrating liner wear and metalosis (b) Severe metalosis and osteolysis (c) Radiographs after revision surgery including excising mass, changing to metasul liner and metal head after cementing

Fig. 4

A 68-year-old male patient with right total hip arthroplasty using large head MoM bearing (a) Preoperative radiograph of acetabular aseptic loosening (b) Large head MoM bearing (c) Radiographs after acetabular revision using CoC bearing

Fig. 5

A 34-year-old male patient with right total hip arthroplasty using CoC articulation (Forte) (a) Radiograph with fractured ceramic head and liner (b) The fractured ceramic head and liner (c) Radiographs after revision surgery changing the ceramic liner and fractured head to metasul liner and metal head after cementing