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Ceramic on Ceramic

Ceramic is very smooth and produces very little wear. There are three limitations to ceramic. One is that it cannot be made as a very large ball. Two, it cannot be made to accommodate for a wide range of leg lengths and three although rare, it may occasionally crack.

Ceramic is a very smooth material, and wear between the surface is up to 1,000 times less than metal on polyethylene! However, ceramic is somewhat brittle, and cracks in the material occasionally develop. Ceramic hips have been the subject of recall in the past. With improved manufacturing, cracks have become very uncommon (about 1 in 25,000 cases). Ceramic has other limitations. The size of the ball must be fairly small (32 - 36mm).

The natural femoral head is fairly large and may vary from about 38mm up to 56mm, or even 60mm or more in very large patients. The larger the ball, the greater the motion of the hip. Large femoral balls have a lower risk of dislocation. (see risks of surgery) Ceramic femoral heads occasionally have an additional concern which is "squeaking". This may be annoying, and in some instances, patients have requested a revision surgery to correct this. Because of these issues, ceramic on ceramic has not been Dr. Clyburn's first choice. He uses it, however, in cases of very young women and patients who are on dialysis. The reason for this is explained under metal ions.