Background: Recently, the use of ceramic-on-polyethylene (CoP) bearing surfaces has increased in the United States with the development of material properties. However, it remains controversial which bearing couples are effective. The purpose of this study was to evaluate the wear and survival rates of third-generation ceramic heads on a conventional polyethylene liner. Methods: We retrospectively reviewed 160 hips (147 patients with a mean age of 56 years) who underwent total hip arthroplasty using the third-generation ceramic head on a conventional polyethylene liner from March 1998 to August 2003. The wear rate was evaluated using the PolyWare program Version 8 (Draftware Developers Inc., IN, USA) in 32 hips followed-up for at least 15 years. In addition, we evaluated the Kaplan-Meier survivorship.Results: Linear wear and volumetric wear rates were 0.102±0.57 mm/year and 30.2±27.5 mm3/year, respectively. Fourteen reoperations due to all causes and 10 revisions were performed during the follow-up period. The 15-year survival rate was 84.1% for any surgery as the endpoint and 87.6% for the revision surgery as the endpoint. Most of the causes of revision were cup loosening, and no ceramic head fracture occurred.Conclusions: The CoP bearing surface maintains the advantages of the soft polyethylene surface and has good resistance to wear. Therefore, alumina ceramic on newer polyethylene could certainly be a good alternative bearing couple without any concern for ceramic fractures, especially in younger patients.Level of evidence: Level III, retrospective cohort design

Purpose: Authors attempt to evaluate the clinical and radiographic results of the treatment of scaphoid nonunion with poor prognostic factors with the free vascularized medial femoral condyle bone graft. Methods: We operated on eight patients with avascular necrosis or prolonged nonunion of the scaphoid between January 2016 and July 2019. Wrist motion in terms of flexion, extension, and ulnar and radial deviation, a visual analogue scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the modified Mayo wrist score, scapholunate angle, and carpal height index were collected in the clinic setting preoperatively and at the latest follow-up in all patients Results: Eight patients with union achieved correction and maintenance of both scapholunate angle and carpal height index. The VAS pain scores significantly improved from 5.1 preoperatively to 3.3 postoperatively. There was a statistically significant improvement in the average DASH score at the final follow-up. Scapholunate relationships in the reconstructed wrists remained almost unchanged, with average scapholunate angles of 49.7° before surgery and 47.0° at the latest postoperative follow-up. There was no statistical significance between the number of poor prognosis factors and the time to union, but there was a positive correlation.Conclusion: It could help surgeons manage the scaphoid nonunion associated with poor prognostic factors such as avascular necrosis, carpal collapse (posttraumatic arthritis), prolonged nonunion, and failed prior scaphoid nonunion surgery.