Ceramic-on-polyethylene THA: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drhip

Ceramic-on-polyethylene THA Introduction (What it is)

Ceramic-on-polyethylene THA is a type of total hip arthroplasty (THA), also called total hip replacement.
It describes the “bearing surface” where a ceramic ball moves against a plastic (polyethylene) liner.
This design is commonly used in modern hip replacement to help the joint move smoothly.
It is selected as part of a broader surgical plan based on patient factors and implant options.

Why Ceramic-on-polyethylene THA used (Purpose / benefits)

Total hip arthroplasty is performed to replace a damaged hip joint when pain and loss of function persist despite non-surgical care. The main goal is to relieve pain, improve mobility, and restore daily function by replacing worn joint surfaces with implants.

In Ceramic-on-polyethylene THA, the “ceramic” component is typically the femoral head (the ball at the top of the thigh bone), and the “polyethylene” component is the acetabular liner (the plastic insert inside the hip socket). This pairing is designed to create a low-friction articulation, aiming to support smooth motion and limit wear debris over time compared with some other bearing combinations. Wear matters because microscopic particles can trigger inflammation around the implant and contribute to bone loss (osteolysis) in some cases.

This bearing couple is also commonly discussed in the context of reducing concerns associated with metal-on-metal designs, such as elevated metal ion levels. Ceramic heads do not corrode the way metals can, and polyethylene liners have evolved with different formulations and manufacturing methods intended to improve wear performance. The practical benefits and tradeoffs vary by clinician and case, and also by material and manufacturer.

Indications (When orthopedic clinicians use it)

Orthopedic clinicians may consider Ceramic-on-polyethylene THA in scenarios such as:

Symptomatic hip osteoarthritis (wear-and-tear arthritis) that limits walking, sleep, or daily tasks
Hip arthritis related to prior injury (post-traumatic arthritis)
Inflammatory arthritis affecting the hip (pattern and severity vary)
Avascular necrosis (loss of blood supply to the femoral head) with joint surface collapse
Certain displaced hip fractures in older adults where replacement is chosen over fixation (selection varies)
Failed prior hip surgery, such as a painful or worn-out older implant requiring revision planning
Patients where a low-wear bearing is preferred as part of an overall implant strategy
Situations where avoiding metal-on-metal bearing surfaces is desired

Contraindications / when it’s NOT ideal

Ceramic-on-polyethylene THA may be less suitable, or require special consideration, in situations such as:

Active infection in or around the hip joint (hip replacement is generally delayed until addressed)
Severe medical instability where major surgery risk is high (timing and approach vary by case)
Poor bone quality or bone loss that makes implant fixation challenging without additional techniques
Complex deformity or anatomy where other implant designs may better address stability or fixation
High risk of hip instability/dislocation where alternative constructs (for example, dual mobility designs) may be considered
Known or suspected allergy/sensitivity concerns related to other implant components (bearing choice is only one factor)
Cases where surgeon experience, available implant systems, or revision plans favor a different bearing
Situations where a different wear profile or mechanical property is prioritized (varies by clinician and case)

“Not ideal” does not mean “not possible.” It usually means the bearing surface choice is weighed alongside fixation method, head size, stability, and patient-specific risks.

How it works (Mechanism / physiology)

A healthy hip is a ball-and-socket joint. The femoral head (ball) at the top of the femur fits into the acetabulum (socket) in the pelvis. Articular cartilage coats both sides, allowing smooth motion and distributing loads. In arthritis or structural damage, cartilage wears away, the joint space narrows, and bone can rub on bone—leading to pain, stiffness, and reduced function.

Total hip arthroplasty replaces the damaged joint surfaces. In a typical construct:

A metal stem is placed in the femur and supports a new femoral head (the “ball”).
A metal shell is placed in the acetabulum and holds a liner (the “socket surface”).

In Ceramic-on-polyethylene THA, the ceramic head articulates against a polyethylene liner. The principle is biomechanical: smoother surfaces and favorable material pairing are intended to reduce friction and wear at the bearing interface. The body’s response to wear particles is also part of the physiology. When wear debris accumulates, immune cells can react, potentially contributing to inflammation and bone resorption around the implant in some cases. Modern polyethylene types are manufactured with approaches intended to improve wear resistance, though performance varies by design, positioning, activity, and material and manufacturer.

“Reversibility” does not apply in the way it does for a medication; THA is an implant-based reconstruction. However, implants can be revised (surgically replaced or adjusted) if problems occur, and revision complexity depends on the reason for failure and the condition of the bone and soft tissues.

Ceramic-on-polyethylene THA Procedure overview (How it’s applied)

Ceramic-on-polyethylene THA is not a standalone procedure separate from hip replacement. It is a bearing choice within a total hip arthroplasty plan. A high-level workflow often includes:

Evaluation / exam – History of symptoms (pain location, stiffness, functional limits) – Physical exam (range of motion, gait, leg length assessment) – Imaging, typically X-rays; other imaging may be used depending on the question
Preparation – Discussion of surgical vs non-surgical options and expected goals – Review of medical conditions, medications, and perioperative planning – Implant planning: fixation (cemented vs cementless), head size, liner type, and bearing surface (including Ceramic-on-polyethylene THA)
Intervention (THA surgery) – The damaged femoral head is removed and the femoral canal is prepared for a stem – The acetabulum is prepared for a shell and liner – A ceramic head is placed on the femoral stem and paired with a polyethylene liner in the socket – Soft tissues are repaired as needed to support stability and function
Immediate checks – Assessment of hip stability through a range of motion (intraoperative) – Leg length and implant position checks (methods vary) – Postoperative imaging is commonly used to document component position
Follow-up – Monitoring wound healing, pain control, mobility progress, and complications – Rehabilitation planning and gradual return to activities (timelines vary by clinician and case)

Specific surgical approaches, hospital stay, and rehab protocols differ widely.

Types / variations

Ceramic-on-polyethylene THA can vary in several ways. Common variations include:

Ceramic femoral head materials
Different ceramic formulations exist (for example, alumina-based ceramics and composite ceramics). Properties such as toughness and fracture resistance vary by material and manufacturer.
Polyethylene liner types
Conventional polyethylene and highly crosslinked polyethylene are broad categories often discussed. Crosslinking and added stabilizers (manufacturer-specific) may influence wear behavior.
Femoral head size
Ceramic heads come in multiple diameters. Head size selection interacts with stability, range of motion, and liner thickness considerations.
Liner design
Standard liners versus elevated-rim (lipped) liners may be chosen to address stability concerns in some cases. Tradeoffs can include impingement risk depending on component position.
Fixation strategy (part of THA overall)
Cemented vs cementless stems and shells are selected based on bone quality, anatomy, and surgeon preference. This is not specific to Ceramic-on-polyethylene THA but affects overall outcomes.
Primary vs revision THA
Ceramic-on-polyethylene bearings are used in both primary replacements and some revision scenarios, though revision planning depends heavily on existing components and bone loss patterns.
Dual mobility concepts
Some hip systems use a polyethylene component that moves in more than one interface to enhance stability. Whether the femoral head is ceramic can vary by design.

Pros and cons

Pros:

May provide a smooth, low-friction bearing surface for hip motion
Ceramic heads avoid metal-on-metal articulation and related concerns
Polyethylene liners are widely used, with many design options
Bearing choice is compatible with many common THA implant systems
Often considered a balanced option across different ages and activity levels (varies by clinician and case)

Cons:

Polyethylene wear can still occur over time; performance varies by material and manufacturer
Ceramic components can be more sensitive to handling and compatibility requirements than some metal heads (implant-specific)
Certain noises (for example, squeaking) are discussed more often with some ceramic bearings; frequency varies by design and situation
Implant cost and availability can differ across systems and regions
Outcomes depend heavily on implant positioning, soft-tissue tension, and patient factors—not just the bearing surface

Aftercare & longevity

Aftercare following THA focuses on healing, restoring mobility, and reducing complication risk. Longevity is influenced by multiple factors rather than a single material choice.

Key factors that may affect outcomes and implant lifespan include:

Underlying diagnosis and severity: Advanced deformity, bone loss, or inflammatory disease can affect complexity and recovery.
Implant positioning and stability: Component alignment and soft-tissue balance influence function, dislocation risk, and wear.
Rehabilitation and activity progression: Structured rehab supports strength, gait, and movement control; specifics vary by clinician and case.
Body weight and overall conditioning: Joint loading and muscle support can influence symptoms and wear patterns over time.
Bone quality and fixation: Cemented vs cementless fixation interacts with bone health and long-term fixation behavior.
Comorbidities: Conditions such as diabetes, vascular disease, or smoking history can affect healing and complication risk.
Follow-up practices: Periodic clinical review and imaging (as chosen by the treating team) can help detect changes such as wear, loosening, or osteolysis.

No implant lasts forever in every person, and no single bearing guarantees a specific timeframe. Longevity varies by clinician and case.

Alternatives / comparisons

Ceramic-on-polyethylene THA is one option within a broader spectrum of hip care and implant choices.

Common alternatives and how they compare at a high level:

Non-surgical management (observation, activity modification, physical therapy, medications)
Often used for earlier or less severe arthritis, or when surgery is not desired or not appropriate. These options can reduce symptoms but do not replace damaged joint surfaces.
Injections (for symptom management)
Injections may be used for temporary symptom relief in certain diagnoses. They do not correct structural joint damage and their role varies by clinician and case.
Hip preservation surgery
Procedures aimed at preserving the native hip (for example, addressing impingement or dysplasia) may be considered in selected patients, typically earlier in disease. They are not a direct substitute for THA in end-stage arthritis.
Hip resurfacing
Resurfacing replaces joint surfaces differently than THA and often uses metal-on-metal bearings in many systems. It may be considered in selected patients, but candidacy criteria can be strict and vary by surgeon and region.
Other THA bearing surfaces
Metal-on-polyethylene: A commonly used alternative; modern metal heads paired with advanced polyethylene can perform well. Selection depends on factors like availability, cost, and surgeon preference.
Ceramic-on-ceramic: Uses ceramic on both sides of the bearing; it is sometimes chosen for wear considerations but has its own tradeoffs (such as noise and component-specific risks).
Metal-on-metal: Used far less often in many settings due to concerns about metal wear debris and ion levels; still may appear in legacy implants.

Bearing choice is only one part of THA planning, alongside approach, fixation, stability strategy, and patient-specific goals.

Ceramic-on-polyethylene THA Common questions (FAQ)

Q: What does Ceramic-on-polyethylene THA mean in plain language?
It means your hip replacement uses a ceramic ball that moves against a durable plastic socket liner. This pairing is one of several “bearing surfaces” surgeons can select. The rest of the implant typically includes metal components that anchor the ball and liner to bone.

Q: Is Ceramic-on-polyethylene THA used for arthritis or for fractures too?
It is most commonly associated with hip replacement for arthritis-related pain and stiffness. It may also be used when hip replacement is chosen for certain fractures, especially in older adults. The decision depends on the fracture pattern, patient health, and surgical goals.

Q: How long does a Ceramic-on-polyethylene THA last?
There is no single lifespan that applies to everyone. Longevity depends on factors like implant design, positioning, activity level, body weight, bone quality, and follow-up over time. Your clinician may discuss expectations based on your specific situation.

Q: Does a ceramic head reduce the chance of metal ion problems?
Ceramic heads do not produce metal ions from a metal-on-metal bearing because the bearing is ceramic against polyethylene. However, hip implants may still include metal parts elsewhere, and overall risk depends on the entire implant system and how it functions in the body. Concerns about metal ions are typically more central in metal-on-metal designs.

Q: Is the recovery different compared with other hip replacement bearings?
Rehab and recovery are usually driven more by the surgical approach, fixation method, soft-tissue condition, and individual health than by the bearing surface alone. Bearing choice can matter for long-term wear considerations, but early recovery milestones often follow similar principles. Protocols vary by clinician and case.

Q: Will I be fully weight-bearing right away?
Weight-bearing instructions depend on surgical details, bone quality, fixation, and any added procedures performed during the operation. Many patients are allowed to bear weight relatively early after routine primary THA, but this is not universal. Your surgical team sets precautions based on intraoperative findings and implant stability.

Q: When can I drive or return to work after Ceramic-on-polyethylene THA?
Timelines vary based on which hip was operated on, pain control, mobility, reaction time, and the type of work you do. Desk-based work often differs from physically demanding work in timing and restrictions. Your treating team typically provides clearance criteria rather than a single date.

Q: Does Ceramic-on-polyethylene THA have specific risks I should know about?
All THA involves general risks such as infection, blood clots, dislocation, fracture, leg length differences, nerve irritation, and implant loosening over time. For Ceramic-on-polyethylene THA specifically, the key discussion points often include polyethylene wear behavior and ceramic component handling/compatibility considerations. The relevance of any risk depends on implant design and individual factors.

Q: How much does a Ceramic-on-polyethylene THA cost?
Cost varies widely by country, hospital system, insurance coverage, implant vendor contracts, and whether the surgery is primary or revision. The bearing surface can influence implant pricing, but it is only one part of total episode-of-care cost. Billing questions are usually best addressed through the surgical facility and insurer.