ABSTRACT
In 1960 Charnley [1] opened the age of low friction arthroplasty with the introduction of polyethelene sockets in articulation with metal balls; in 1970 Boutin [2] commenced the period of low wear arthroplasty by the application of alumina ceramic to hip surgery. This ceramic had been recommended for reconstructive surgery after preliminary studies by Hulbert et al. [3], Kawahara [4], and Sandhaus [5] in the late 1960s. Boutin [6] was the first to replace polyethylene sockets and metal balls by Al2O3 ceramic components for total hip joint replacements, soon followed by Langer [7] with partial tibia plateau inserts. Independently, Griss et al. [8] and Mittelmeier et al. [9] initiated extensive compatibility studies which confirmed the bioinertness of this material and indicated the possibility of a marked reduction of all wear-related phenomena and a direct, cement-free anchorage of the acetabular component if the shape of the implant accounts for the remodeling ability under the influence of the stress and strain field created by the implant in the adjacent bony tissue [10]. More than three million alumina ceramic components of different designs have been inserted since, mostly as joint replacements and dental implants. The expected wear reduction in total joint replacements [11,12] as well as the direct anchorage of alumina ceramic dental implants [13] were widely confirmed. The cement-free anchorage of these monolithic ceramic hip sockets, however, was abandoned after about 10 years because of a too high number of late cup migrations, and was replaced by composite sockets consisting of a metal backing providing a stable anchorage in the pelvis and a ceramic inlay for minimizing all wearrelated problems (for a review see Ref. 14).
