Ceramic on Ceramic Total Hip: a 40 Years History

Ceramic on ceramic couple in total hip was introduced in France by Pierre Boutin in the early seventies. Initial problems related to fractures or difficulties in setting ceramic onto metal were documented. Quickly it appeared many advantages of this material, resuming in absence of foreign body reaction, excellent longevity, and ability to practice sports without any problems. At the moment it is recognised to provide long term results without osteolysis. Morevover some recent data's insisted on the absence of long term dislocation. This could be related to the strong fibrous tissue generated by this material. Also, some papers do insist on the reduction in infection burden with this material. Nowadays, it represents about 40% of couple implanted wolrdwide including France, Italy, UK, Germany and South Corea. It is recommanded to be applied in youger and more active patients. In the United States, it was prefered during years to utilise metal on metal. But due to many problems of this material including pseudotumors, pain, revision burden, ceramic on ceramic use is increasing. We have published data's showing about 10% revision at 20 years. Considering a good material quality, an excellent design of the construct and awareness of the surgeon, this material could be recommanded for very long term implantation in the more active population. Problems of fracture or noise even of concern are very anecdotical and must be balanced with the documented advantages of this material.