Hip Replacement: Materials for Hip Ball and Socket Surgery

Dr. Bassam Masri, MD, FRCSC, discusses the different materials used in a hip ball and socket replacement.

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Dr. Bassam Masri, MD, FRCSC, discusses the different materials used in a hip ball and socket replacement.
Video transcript

Featuring Dr. Bassam Masri, MD, FRCSC

Duration: 2 minutes, 52 seconds

If a patient is diagnosed with significant  osteoarthritis of the hip with significant pain that is not responding to non-operative treatment, which includes medications, the use of a cane, and staying active and fit, then the consideration is that of a hip replacement.  

So why are there different options for the bearing surface in hip replacement? In the old days, the traditional bearing surface, and when I say bearing surface, I mean the articulation of the hip, and the hip being a ball and a socket joint, so what is the material of the ball or the femoral head and the socket, which is the liner of the acetabulum.  

Traditionally, this has been metal on plastic. And over the years, we have learned that plastic can wear with time, and the byproducts of the plastic wear can lead to significant bone loss and failure of the hip joint, leading to fairly catastrophic revisions.  

In the late 1990s, the old traditional plastics that we were using, which were ultra-high molecular weight polyethylene that was sterilized using gamma radiation and air, were replaced with what’s now called highly cross-linked polyethylene. And the vast majority of patients in North America now would get this highly cross-linked polyethylene.  

What we have learned over the past decade is that the newer highly cross-linked polyethylene wears much, much less than the previous generations of plastic. And now we are no longer seeing the catastrophic wear and the catastrophic failures that we were seeing 15 and 20 years ago.  

And that has been very, very encouraging. And ceramic on ceramics were also an alternative to metal on plastic because of the older problems with wear of the plastic. With more current data, up to 10 years, the failure rate of ceramic on ceramic and metal on plastic is exactly the same.

However, some surgeons still recommend ceramic on ceramic for very young patients because of the potential less wear at 20, 30 and 40 years. So for really young patients, it may be an attractive option, although there is no evidence to support that it is better than metal on plastic.

There are two potential complications with ceramic on ceramic that are not present with metal on plastic. They’re rare, but they can happen. And that’s squeaking, so audible squeaking that can be quite bothersome in rare events.  

And also very rarely, the ceramics can fracture and need a revision. They’re rare events, but they can still happen.  And this is why the standard of care in North America remains metal on plastic.

Once a decision has been made to perform a hip replacement, the patient should discuss the various treatment options for a hip replacement with the surgeon.

Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC

Local Practitioners: Orthopaedic Surgeon

Video Quiz ( 557 participated.)

Test your knowledge by answering the following questions:


Hip replacement surgery is available to anyone who suffers ongoing hip pain. 


There are different materials that a surgeon can use when doing a hip ball and socket replacement.


Hip ball and socket materials such as plastic on plastic and ceramic on ceramic are both viable options to choose from when undergoing a hip replacement.

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.