Alternative bearing surfaces for total joint arthroplasty

The biologic response to polyethylene particulate debris generated from metal-on-polyethylene bearing surfaces is thought to be largely responsible for periprosthetic osteolysis and aseptic loosening in total joint arthroplasty. As a result, there has been an interest in developing polyethylene with improved wear characteristics, as well as a renewed interest in alternative bearing surfaces for total joint arthroplasty, including ceramic-polyethylene, metal-metal, and ceramic-ceramic articulations. These alternative surfaces have demonstrated less friction and lower wear rates than metal-on-polyethylene bearing surfaces in both clinical and laboratory experiments. Clinical results, although only short- to mid-term, have been encouraging. Alternative bearing surfaces, with lower wear rates and less particulate debris formation, may have the potential to improve total joint arthroplasty survivorship by decreasing periprosthetic osteolysis, especially in younger, high-demand patients.