Outcomes of Ceramic Composite in Total Hip Replacement Bearings: A Single-Center Series

A Comprehensive Literature Review of Total Hip Arthroplasty (THA): Part 1-Biomaterials

The rapid advancement of materials science has revolutionized total hip arthroplasty (THA), a critical orthopedic procedure aimed at restoring mobility and improving patient quality of life. This review investigates the evolution of biomaterials used in THA, analyzing their mechanical, biological, and chemical properties. The study outlines the transition from early natural materials to modern metals, polymers, and ceramics, highlighting their benefits and limitations in clinical applications. Particular emphasis is placed on the development of advanced materials such as highly cross-linked polyethylene (HXLPE), zirconia-toughened alumina (ZTA), and tantalum alloys (Ta), which demonstrate enhanced biocompatibility, wear resistance, and longevity. By examining emerging trends, including bioactive coatings and nanotechnology, this paper aims to provide a comprehensive understanding of current challenges and future directions in material selection for hip prostheses, ultimately aiming to minimize annual revision rates and improve long-term outcomes.

Long-term surgical outcomes of hemiarthroplasty for patients with femoral neck fracture with metal versus ceramic head in Taiwan

AIMS

Hip fractures are a significant health concern, especially in the elderly. Hemiarthroplasty has been the preferred treatment for displaced femoral neck fractures. The use of ceramic femoral heads has recently become popular due to their claimed durability. This study aimed to determine long-term outcomes associated with different implant choices in hemiarthroplasty.

METHODS

The study sample included patients aged 50 years and above, with an index femoral neck fracture admission and hip hemiarthroplasty identified from Taiwan's National Health Insurance (NHI) claims data (2009-2019). To compare two groups of users of different heads, we performed 1:2 matching of the ceramic group versus metal group according to age, gender, index year, and six major comorbidities. Cumulative incidence rates were assessed for revision, post-operative complications, and medical complications. Cause-Specific hazard Cox models were used to estimate the hazard ratios for the two different implants groups.

RESULTS

Among 47,158 patients, 2559 out of 2637 who received ceramic head hemiarthroplasty with co-payment, were successfully matched with 5118 receiving metal head prostheses fully covered by the NHI. Over a mean follow-up of 3.12 years, no significant differences were observed in revision rates between the ceramic and metal head groups. The ceramic head group demonstrated significantly lower risks of postoperative complications and medical complications within 90 days than the metal head group.

CONCLUSIONS

This study found ceramic implant had lower postoperative complications and medical complication rates than metal head implant in hip hemiarthroplasty, but there was no difference in the revision rates between the two heads.

Good clinical outcomes following total hip arthroplasty using large-diameter ceramic-on-ceramic bearings

Large-diameter heads (LDHs) in total hip arthroplasty (THA) enhance range of motion but require thinner liners. Monoblock acetabular components with ceramic liners could reduce liner fracture risks during modular acetabular component assembly. This study aims to confirm the safety and clinical performance of the monoblock Maxera Cup in THA. The study included 198 consecutive patients who received 214 primary monoblock acetabular components with an LDH ceramic-on-ceramic (CoC) bearing between March 2012 and December 2013. We collected Harris hip scores (HHS), Oxford hip scores (OHS), EuroQoL-5D scores (EQ-5D), and conducted radiographic evaluations. Seven patients (3.5%) died for reasons unrelated to the intervention. A single patient (0.3%) underwent cup revision due to recurrent dislocation from trauma. Another patient needed cup revision six years post-surgery due to squeaking. Mean follow-up time was 36.2 ± 27.9 months. Kaplan-Meier survivorship rate at 96 months for any component loosening was 100%, and the cup revision survivorship rate for any reason was 96.8% (95% CI, 87.8-99.5%). At final follow-up, mean HHS was 93.6 ± 9.9, OHS was 16.2 ± 5.9, and EQ-5D was 0.94 ± 0.09. LDH CoC THA using a monoblock cup yielded excellent medium-term functional outcomes. This approach eliminates liner fracture risk during insertion and reduces implant impingement risk.

Optimal Design of Ceramic Based Hip Implant Composites Using Hybrid AHP-MOORA Approach

Designing excellent hip implant composite material with optimal physical, mechanical and wear properties is challenging. Improper hip implant composite design may result in a premature component and product failure. Therefore, a hybrid decision-making tool was proposed to select the optimal hip implant composite according to several criteria that are probably conflicting. In varying weight proportions, a series of hip implant composite materials containing different ceramics (magnesium oxide, zirconium oxide, chromium oxide, silicon nitride and aluminium oxide) were fabricated and evaluated for wear and physicomechanical properties. The density, void content, hardness, indentation depth, elastic modulus, compressive strength, wear, and fracture toughness values were used to rank the hip implant composites. It was found that the density and void content of the biocomposites remain in the range of 3.920-4.307 g/cm3 and 0.0021-0.0089%, respectively. The composite without zirconium oxide exhibits the lowest density (3.920 g/cm3), while the void content remains lowest for the composite having no chromium oxide content. The highest values of hardness (28.81 GPa), elastic modulus (291 GPa) and fracture toughness (11.97 MPa.m1/2) with the lowest wear (0.0071 mm3/million cycles) were exhibited by the composites having 83 wt.% of aluminium oxide and 10 wt.% of zirconium oxide. The experimental results are compositional dependent and without any visible trend. As a result, selecting the best composites among a group of composite alternatives becomes challenging. Therefore, a hybrid AHP-MOORA based multi-criteria decision-making approach was adopted to choose the best composite alternative. The AHP (analytic hierarchy process) was used to calculate the criteria weight, and MOORA (multiple objective optimisation on the basis of ratio analysis) was used to rank the composites. The outcomes revealed that the hip implant composite with 83 wt.% aluminium oxide, 10 wt.% zirconium oxide, 5 wt.% silicon nitride, 3 wt.% magnesium oxide, and 1.5 wt.% chromium oxide had the best qualities. Finally, sensitivity analysis was conducted to determine the ranking's robustness and stability concerning the criterion weight.

Editorial for the Special Issue on Bioceramic Composites

This Special Issue on bioceramic composites and its published papers, addressing a number of current topics from industry and academia, are intended to be a reference for students and scholars in the field of biomaterials science, giving an insight into challenges and research topics in the field bioceramic composites [...]