Ceramic Total Knee Arthroplasty: Ready to Go?

Abstract

Total knee arthroplasty (TKA) is a well-established surgical procedure in the late stages of knee osteoarthritis. Nevertheless, this procedure is associated with a percentage of unsatisfactory results and biomechanical failures, with aseptic loosening being the most common cause of revision. Beside these problems, cutaneous and systemic hypersensitivity reactions to metals have arisen as an increasing concern after joint arthroplasties, even if allergies against implant materials are still a quite rare and not well-known problem. Ceramic composites have been recently used in prosthetic components, showing minimum wear and excellent long-term results in total hip replacement, due to their high resistance to scratching and their better wettability with respect to cobalt–chromium alloy. Furthermore, the biologic response to debris generated from these bearings is less aggressive. Knee joint simulator tests and clinical results demonstrate promising results of TKAs with ceramic components that should led to benefit for the patients.

The evolution of patellofemoral prosthetic design in total knee arthroplasty: how far have we come?

“…82,83 Ceramics have faced challenges with regard to fixation at the implant bone interface, but have also shown good survivorship at 10 and 15 years in TKA. 84–86 Polyetheretherketone (PEEK) is currently being investigated as an alternative material in TKA and has shown promising results in vitro. 87…”

The Mechanisms Underlying the Biological Response to Wear Debris in Periprosthetic Inflammation

“…However, the brittleness of the material that increases the risk of breakage (Howard et al, 2017) and the noise from the implant such as squeaking (Swanson et al, 2010) are still important disadvantages of the CoC bearing surfaces. Regarding bearing surfaces in knee replacement implants, UHMWPE of the tibial insert can articulate against metal or ceramic femoral components (Oonishi et al, 2009;Inacio et al, 2013), although ceramic femoral components are yet rarely used in clinical practice (Solarino et al, 2017).…”

Biomechanical and Tribological Aspects of Orthopaedic Implants

“…At the present time, all-ceramic knee endoprosthesis is not a feasible option. Several TKA designs having a ceramic femoral component articulating on polyethylene are available for clinical use or are under clinical trial [45][46][47]. These devices represent a promising alternative for patients with a known hypersensitivity to metals, but it is still early to draw conclusions regarding their long-term outcomes in terms of longevity, wear damage and incidence of brittle fracture.…”