Alternate bearing surfaces in total joint arthroplasty: biologic considerations

The problem of periprosthetic osteolysis is currently the major limiting factor in joint arthroplasty longevity. Because this process has been shown to be primarily a biologic response to wear particles, corrosion products, or both, efforts to reduce particle generation are being undertaken. These efforts include the development of modified polyethylene and alternative articulating surfaces. These alternate bearing surfaces currently include ceramic-on-polyethylene, ceramic-on-ceramic, and metal-on-metal. Although these alternate bearings diminish or eliminate the generation of polyethylene particles, ceramic and metal particles are produced. The purpose of the current review is to discuss the literature that addresses the biologic response to these particles, locally and systemically.