What future for zirconia as a biomaterial?

The failure events of Prozyr® femoral heads in 2001–2002 have opened a strong, controversial issue on the future of zirconia as a biomaterial. The aim of this paper is to review and analyze the current knowledge on ageing process and on its effect on the long term performance of implants in order to distinguish between scientific facts and speculation. Current state of the art shows the strong variability of zirconia to in vivo degradation, as a consequence of the strong influence of processing on ageing process. As different zirconia from different vendors have different process related microstructure, there is a need to assess their ageing sensitivity with advanced and accurate techniques, and ISO standards should be modified, especially to gain confidence from clinicians. There is a trend today to develop alumina–zirconia composites as an alternative to monolithic alumina and zirconia: the issue of ageing is also discussed for these composites.