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Philippe Hernigou Hôpital Henri Mondor, University of Paris-Est, France

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François Roubineau Hôpital Henri Mondor, University of Paris-Est, France

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Charlie Bouthors Hôpital Henri Mondor, University of Paris-Est, France

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Charles-Henri Flouzat-Lachaniette Hôpital Henri Mondor, University of Paris-Est, France

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Introduction Ceramic-on-Ceramic (CoC) articulating surfaces are well known to combine properties of a high-strength, scratch-resistant material with very low coefficients of friction averaging 0.02, mimicking those of a normal joint. Their

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Claude B. Rieker Zimmer Biomet, Switzerland

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ranges from small asymptomatic cysts to large soft tissue masses (pseudotumours). 37 Ceramic-on-ceramic articulations After MoM, ceramic-on-ceramic (CoC) articulation, developed in France by Boutin in 1970, 38 was the second ‘alternative

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Georgios Tsikandylakis Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden

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Soren Overgaard The Danish Hip Arthroplasty Register, Aarhus, Denmark
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Johan Kärrholm Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
The Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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standard in many countries. 4 Introduction of metal-on-metal articulations, ceramic-on-ceramic and, above all later on, highly cross-linked polyethylene opened the possibility for the use of bigger head sizes, but recent studies have suggested limited

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Italy

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Enrico Gallazzi Hip Department, IRCCS Istituto Ortopedico Galeazzi, Italy

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heads (MoPE or CoPE). XLPE has been reported with less wear (MoXLPE or CoXLPE), but also with a decrease in mechanical proprieties; ceramic-on-ceramic (CoC) is related to much less wear and the highest bio-tolerability but carries the risk of breakage

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J R W Crutsen Department of Orthopaedic Surgery, VieCuri Medical Center, Venlo, the Netherlands

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M C Koper Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Zoetermeer, the Netherlands

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J Jelsma Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands

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M Heymans Zuyderland Academy, Centre of Knowledge and Information (KIC), Zuyderland Medical Centre, Sittard-Geleen, the Netherlands

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I C Heyligers Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands
School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands

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B Grimm Luxembourg Institute Health, Human Motion, Orthopaedics, Sports Medicine, Digital Methods (HOSD), Luxembourg, Luxembourg

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N M C Mathijssen Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Zoetermeer, the Netherlands

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M G M Schotanus Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands
School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands

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MoP Fracture CoC implant Low Good C/P, central and peripheral; CoC, ceramic-on-ceramic; CoP, ceramic-on-polyethylene; MoM, metal-on-metal; MoP, metal-on-polyethylene; NOS, Newcastle–Ottawa Scale; P, plasma; ppb, parts per billion; S

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Didier Hannouche Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland

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Matthieu Zingg Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland

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Hermes Miozzari Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland

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Remy Nizard Department of Orthopaedic Surgery, AP-HP, Hôpital Lariboisière, Paris University, Paris, France

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Anne Lübbeke Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland

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.025%, respectively, according to the manufacturer. Similar findings have been reported by Howard et al 35 in the largest independent study on fractures of ceramic-on-ceramic bearings. The study included 111 681 ceramic-on-ceramic THAs (79 442 AMC and 31 982 Al

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Carsten Perka Center for Musculoskeletal Surgery, Charité Medical University Center, Berlin, Germany

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Maziar Mohaddes Hässleholms Hospital, Region Skåne, Hässleholm, Sweden
Orthopedics, Faculty of Medicine, Department of Clinical Sciences, Lund University, Malmö, Sweden

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Axel Ekkernkamp BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany

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Niklas Keller Harding Center for Risk Literacy, University of Potsdam, Faculty of Health Sciences, Potsdam, Germany

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Dirk Stengel BG Kliniken – Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany

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–zirconia-ceramics-on-highly cross-linked polyethylene with or without antioxidants, HXLPE) and hard-on-hard (i.e. ceramic-on-ceramic) pairings are the most common in use, all of which have distinct risk–benefit profiles ( 7 , 8 ). The idea of using alumina ceramics as a fabric

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Khaled M. Sarraf St Mary’s Hospital, Imperial College Healthcare Trust, London, UK

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Ravi Popat St Mary’s Hospital, Imperial College Healthcare Trust, London, UK

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Kathryn L. Kneale St Mary’s Hospital, Imperial College Healthcare Trust, London, UK

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Rajarshi Bhattacharya St Mary’s Hospital, Imperial College Healthcare Trust, London, UK

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Manoj Ramachandran The Royal London Hospital, Barts Health NHS Trust, London, UK

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Pramod Achan The Royal London Hospital, Barts Health NHS Trust, London, UK

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Sammy A. Hanna The Royal London Hospital, Barts Health NHS Trust, London, UK

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three studies ( n = 94) specified the bearing surfaces used. There were 28 metal-on-polyethylene, 23 ceramic-on-ceramic, nine ceramic-on-polyethylene and 35 metal-on-metal. The demographics of the patients in the studies are summarized in Table 1

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Claus Varnum The Danish Hip Arthroplasty Register
Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark

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Alma Bečić Pedersen Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

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Per Hviid Gundtoft Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark

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Søren Overgaard The Danish Hip Arthroplasty Register
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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will be illustrated based on a study by Varnum et al 9 published in 2015: the aim was to compare cementless THA with ceramic-on-ceramic (CoC) bearings with metal-on-polyethylene (MoP) bearings in patients identified from the DHR. This was a

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Vasileios F Pegios Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece

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Eustathios Kenanidis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece

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Stavros Tsotsolis Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece
Department of Trauma and Orthopaedics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

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Michael Potoupnis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece

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Eleftherios Tsiridis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Thessaloniki, Greece

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risk, with ceramic-on-polyethylene being the most beneficial, followed by ceramic-on-ceramic, metal-on-polyethylene and finally by metal-on-metal bearing surfaces ( 51 , 52 , 53 , 54 , 55 ). Acetabular screws favor primary stability and ensure

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