[20 years aluminum oxide ceramics for medical applications]

For the past 20 years, femoral heads have been successfully employed for modular total hip prostheses. To date, some 2 million ceramic femoral heads have been implanted, mainly in Europe, but also in North America and Japan. The majority of these are BIOLOX heads having a diameter of 28 mm and with the so-called European taper 12/14. The most important properties and the arguments in favour of using alumina ceramic for total hip prostheses are outlined, and safety aspects discussed. Some secondary requirements for these systems with ceramic cups or cup inserts, which are now meeting with increased interest, are considered.