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Ceramic bearing couples in THA

What is the impact of surgical technique with ceramic bearing couples on clinical outcomes in THA?

What is the impact of surgical technique with ceramic bearing couples on clinical outcomes in THA?
In a recent review paper published in the Journal of Biological Regulators and Homeostatic Agents, M. Saracco, G. Maccauro and C. Piconi emphasized that in addition to the selection of a biologically sound implant material like ceramic, preoperative planning and appropriate surgical implant technique play a decisive role for long term outcomes in hip replacement. 
 
In their paper, Saracco et al. review the clinical usage of ceramics in THA over the last 40 years. The authors show that the correct positioning of THA system components is crucial for a long-term survival and has to be individually adapted to the patient's joint geometry and kinematics to decrease the risk of impingement, component failure or dislocation. Ceramic components have
been clinically proven to achieve excellent long term results (up to 20 years survival rate).
The authors highlight in their review that CoC bearings have proven to be particularly suitable for active patients independently of their age due to their extreme low wear rate without causing local or systemic toxicity.

Reference: Saracco M, Passiatore M, Cazzato G, Ziranu A, Piconi C. and Maccauro G., Journal of Biological Regulators and Homeostatic Agents, Jul-Aug 2020;34(4 Suppl. 3):237-242