Ceramic resurfacing: the future and challenges

Ceramics have a history of use in total hip replacement (THR) including early use in hip resurfacing. Improvements in ceramics over the past two decades have resulted in the BIOLOX^® delta material which has a higher fracture resistance, low wear and excellent biocompatibility compared to other orthopaedic biomaterials. Cobalt Chromium Molybdenum (CoCrMo) metal alloy continues to be used in hip resurfacing but is generally limited to use of larger sizes in active males due to a legacy of concerns with metal ion release from discontinued devices and large diameter modular head trunnions. A novel hip resurfacing device (ReCerf^®, MatOrtho Ltd., UK) utilises BIOLOX^® delta, removing CoCrMo metal from the prosthesis. ReCerf^® is based on a clinically successful design from the same manufacturer (ADEPT^®, MatOrtho Ltd., UK) and although BIOLOX^® delta is a clinically proven material in THR, it requires significant testing to prove safety in the clinical environment. Increasing regulations particularly in Europe, has increased the time to market for new devices such as this and whilst the changes are being implemented to ensure the lowest risk for patients, they are also leaving patients unable to access new treatment routes. Ultimately, it is long term clinical outcomes that are required to determine whether the future of resurfacing is in using alternative materials such as ceramic and whether these compare favourably with the established, successful metal designs which have been in clinical use for over 20 years.