I have used ceramic-on-ceramic (COC), and favor the Wright Alumina ceramic (due to it’s unsurpassed wear characteristics), but I prefer not to use them in my male patients. The main reason is that men tend to be harder (in terms of impact) on their hips than female patients, which can lead to ceramic fracture. The Depuy option has Delta Ceramic (which is more fracture resistant, but also less wear resistant).
Squeaking has been directly attributed to “system” problems, and seems not to be related to the specific bearing, but rather which stem & cup are being used with that bearing. Neither Depuy nor Wright have had major issues with squeaking.
Current trends are moving away from COC bearings in favor of newer Highly Crosslinked Ultra High Molecular Weight Polyethelene (HXL UHMWPE), which is the latest, greatest plastic. Wear rates are not quite as low as COC, but the difference may be clinically negligible.
Even though Metal-On-Metal (MOM) bearings are arguably the most excellent bearing surface (with the most options and the longest track-record… in some cases >30 yrs!) recent litigation is forcing surgeons to steer away from its use due to extremely rare but catastrophic complications.
The current trend in joint replacement is one of the following for young hip bearing surfaces:
- All companies: Delta Ceramic on HXL UHMWPE
- Wright Medical specific: large diameter head Alumina Ceramic (also known as Big Ceramic Head, or BCH – this gives great wear resistance, and the larger head decreases the chance of head fracture) on HXL UHMWPE
- Smith & Nephew specific: ceramicised metal (aka- “Oxinium”) on HXL UHMWPE. The combination is known as “Verilast”.
The idea is to maximize toughness while also maximizing wear resistance. My personal preference is BCH on HXL UHMWPE for most applications. Head sizes for BCH often go above 40mm, which has the nice side-effect of also minimizing dislocation risk because it more closely resembles your natural hip size. I have also used Delta & Verilast for specific circumstances.