Alternate bearing surfaces in total joint arthroplasty - Biologic considerations

The problem of periprosthetic osteolysis is currently the major limiting fa ctor in joint arthroplasty longevity. Because this process has been shown t o be primarily a biologic response to wear particles, corrosion products, o r both, efforts to reduce particle generation are being undertaken. These e fforts include the development of modified polyethylene and alternative art iculating surfaces. These alternate bearing surfaces currently include fera mic-on-polyethylene, ceramic-on-ceramic, and metal-on-metal. Although these alternate bearings diminish or eliminate the generation of polyethylene pa rticles, ceramic and metal particles are produced. The purpose of the curre nt review is to discuss the literature that addresses the biologic response to these particles, locally and systemically.