Ceramic-on-ceramic or ceramic-on-polyethylene bearings have very low wear but carry which risk?

• A. Osteolysis
• B. Ceramic fracture or squeaking
• C. Metallosis
• D. Loosening of tibial component

Answer: (B)

Ceramic bearings offer extremely low wear, which reduces debris and the risk of osteolysis, contributing to durability. But ceramics are brittle, so a crack can propagate if subjected to high loads or malalignment, leading to fracture of the ceramic head or liner. Another notable, though not uncommon, issue is squeaking—a high-pitched noise that can occur with hard-on-hard articulations like ceramic-on-ceramic due to contact mechanics, edge loading, or microseparation. These are the specific risks most associated with ceramic bearings, whereas osteolysis, metallosis, or loosening are more tied to other bearing wear mechanisms.