Y.-S. Park, Y.-W. Moon, and S.-J. Lim reply:
Youn-Soo Park, MD; Young-Wan Moon, MD; Seung-Jae Lim, MD

Risk of ceramic fracture is the single most important reason why orthopaedic surgeons are reluctant to embrace contemporary alumina-on-alumina total hip arthroplasty. One design modification to address this problem is use of a polyethylene-alumina composite liner. Theoretically, the polyethylene backing may improve the toughness of the alumina bearing couples, leading to a reduction of the risk of chipping or actual fracture of the alumina liner during insertion or in vivo use. Although these benefits were demonstrated in one early clinical report6, our experience revealed a worrisome frequency of ceramic failure with the same implant design.

As described by Dr. Benazzo, …

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