Clinical issues of ceramic devices used in total hip arthroplasty

Abstract Ceramics have been successfully used for more than 40 years for orthopedic prostheses, as articulating bearing surfaces against ceramic or polymer components. Nowadays, ceramics remain one of the most used biomaterials in the orthopedic field. Despite the outstanding performance of ceramics, some issues related to their failure still remain, requiring the strong contribution of scientific research to provide resolution to such issues. This paper traces the history of the ceramic materials used in orthopedic clinics, highlighting their mechanical properties and the chemical and physical characteristics, emphasizes the different innovations that have occurred over the years, and finally provides a detailed analysis of the main causes of failure of ceramic hip implants. Alumina was selected as a biomaterial around 40 years ago for its unsurpassed biological safety and stability in the living environment. However, the intrinsic properties of pure alumina limit its mechanical properties, especially the low fracture toughness. For this reason, development of composites was pursued, as a new class of ceramic biomaterials to be used in orthopedics. However, total hip implants present some failures due various causes: i.e., mismatch in female-to-male taper, roundness, roughness or linearity errors in the taper, severe traumatic accidents, etc., which are revised and discussed in the frame of this chapter. Therefore, the aim of this contribution is to illustrate the properties of the ceramics used in total hip arthroplasty and to revise the causes of failures of these biomaterials.