A Systematic Review of the Clinical Efficacy of Oxidized Zirconium as a Bearing Surface in Hip Arthroplasty

Abstract

otal hip replacement (THA) is an established treatment for end stage hip arthritis providing reliable pain free function. The long-term survival of THA depends on multiple factors, But aseptic loosening and wear induced osteolysis are most common causes of failure and search for alternative bearing surfaces became an important issue. The ideal bearing surface for THA should have satisfactory wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. On the femoral head side, historically, cobalt-chromium and ceramic have been the materials of choice as bearing surfaces articulated with the polyethylene liner. A relatively new, alternative type of material that combines the strength of a metal with the wears properties of a ceramic is oxidized zirconium (OxZi) (Oxinium; Smith & Nephew, Memphis, TN). Wear is a gross or microscopic loss of particles from the articulating surface, a process which affecting the longevity of the hip joint, through multiple factors which can be divided into patient, implant and surgical factors. Frictional characteristics are a result of material properties such as wettability, manufacturing variables such as surface finish, and operating conditions such as lubrication. Materials used in the manufacturing of femoral heads for metal-on-polyethylene (MOP) total hip replacement (THR) include the metal alloys, stainless steel, cobalt-chromium, and titanium alloy as well as ceramic materials, aluminum oxide, and zirconium oxide. Properties to consider when evaluating materials for bearings in THR include corrosion resistance, strength, ductility, hardness, and frictional characteristics, So The advantages of using a ceramic on ceramic articulation for total hip arthroplasty are decreasing wear and elimination of osteolysis, Which is the major problem blocking the development of a lifetime hip replacement. The need to eliminate wear and osteolysis has due to indications for total hip arthroplasty to younger; more active, healthier patients with long life expectancies would be recorded.