There are several options for bearing surface combinations in total hip replacement. Fortunately all have very good track records and each bearing brings its own pluses and minuses. By far the most commonly used bearing in the United States today is a cobalt chrome head against a highly cross-linked polyethylene (plastic) insert. This is used in approximately 80% of cases performed.

The next most commonly used bearing is a metal-on-metal alternative. This has very low wear properties but recently a one to two percent incidence of allergic type reaction to metal ions from the articulating surface has been reported. We have reviewed a large series and have presented it at the Western Orthopedic Association documenting our incidence of adverse type reaction as less than 1%. Further study of this bearing surface will take place.

The next most common alternative is ceramic on ceramic. This has an extremely low wear rate but has a documented squeak phenomenon ranging from 2-7%. The etiology of squeaking is not entirely clear but seems to be multifactorial including implant design, surgical technique, and material. Further study will help delineate the most important factors involved in squeaking.

You should discuss with your surgeon which bearing combination is right for you.