CeraNews | To The Point

Our goal is to support you with an overview of relevant current research – brief and to the Point! CeraNews is structured around the following key topics:

  • Implant Material

  • Outcomes Research

  • Health Economics & Policy

We trust that you will find the selected summaries both relevant and valuable.

CeraNews – to the Point is published twice per year. Ideally, we can contribute in this way to the ongoing debate on important topics in orthopedics, and beyond. Ultimately, working towards improved patient outcomes and long-term cost reductions in health care is our mutual motivation and strong link, regardless of our individual role or location. 

 

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CeramTec is committed to selecting and bringing to interested parties relevant articles on bioceramics related topics. The presented authors’ views and opinions are solely those of the authors of these publications. It is the focus and intent of CeraNews that CeramTec presents and comments on the authors’ views and opinions in a specific context. Such comments and editorials therefore solely express CeramTec’s views and opinions and not necessarily those of the quoted authors.


Issue # 12021

Editorial

Guest Editor

Prof. Justin P Cobb
Imperial College
London UK

Dear colleagues,

Isn’t technology wonderful? Vaccine engineering is rescuing the world from the pandemic of Covid-19. On a smaller scale, technology may bring about a revolution in the dusty old world of hip arthroplasty. Two ceramic hip resurfacing products are showcased in this edition of CeraNews – truly innovative devices, in a world where innovation is hard to achieve. The existential battle between conservatives and progressives has been resoundingly won by the conservatives over the last decade as quite a few of the recent ‘improvements’ achieved the opposite of improving things.

 

Large diameter metal-on-metal hip replacements were not a success and many patients had to suffer the consequences. Ceramic was the answer – to avoid any metal-related issues, ceramic femoral heads are now used in most hip replacements worldwide. But thanks to a few pioneers like Harlan Amstutz, who sadly died in May 2021, hip resurfacing has not gone away. Harlan will be sadly missed by his patients, many of whom were prominent athletes. Their return to top-level sport continues to make headlines, backed up by RCT data documenting the significant advantages for resurfaced hips. They enable a faster and more symmetric gait, while patients with THA appear to be slower, with the normal hip doing more of the work1

 

The two-incision approach to the hip has also failed the test of time, while the anterior approach to hip arthroplasty with or without a traction table now has a solid evidence base demonstrating quicker and easier recovery, allowing same-day or overnight surgery in selected patients. Metabolic markers of stress confirm the higher levels of function in the early postoperative period2. This elevation of hip arthroplasty to the ambulatory surgery centres will be a major economic driver, as patients can be treated safely at a lower cost.

 

A ceramic hip resurfacing which combines these two domains has the potential of giving us entirely new options. The muscle sparing approach, avoiding both metal-related issues and a femoral stem, are obviously attractive. However, there is a serious caveat: extended learning curves are well-documented for both the anterior approach and the hip resurfacing procedure. Combining them might even cause additional problems.

 

Again, new technology could contribute importantly to achieve good outcomes. Virtual Reality training in arthroplasty can support surgeons in acquiring new skills in arthroplasty faster and at a higher level3. A growing range of assistive technologies can help to ensure that the surgery’s targets are achieved4, reassuring both patients and their surgeons. After a long 2020, the summer of 2021 has an optimistic feel: technology is overcoming the pandemic, and is also offering the prospect of a next generation of hip arthroplasty options. In my view, the future is looking rosy, well actually pink.

Health Economics & Policy

Hip Resurfacing: Current limitations and new solutions

Hip resurfacing with metal implants is limited by restrictive patient selection. Using ceramic components allows to eliminate metal-related issues and opens new options for this tissuesparing procedure. Thanks to the biocompatible material, hip resurfacing could again become a realistic choice for active patients with a good bone stock.

Outcomes Research

Case Report 1: 60 Years Old High Activity Male Patient with Stated Concerns of Metal Sensitivity

A climbing enthusiast (60 years) with severe hip problems received a ceramic hip resurfacing implant. After successful surgery, he returned to high activity levels very quickly, showing excellent scores in terms of function and gait analysis.

Outcomes Research

Case Report 2: 42 Years Old Female Patient with Dysplastic Hip

An underwater photographer (42 years) with severe hip problems received a ceramic hip resurfacing implant. After successful surgery, she returned to high activity levels very quickly, showing excellent scores in terms of function and gait analysis.

Implant Material

Biocompatibility for a tissue-sparing procedure

Just as in THA bearing couples, ceramics could be the (bio)logical alternative for hip resurfacing, too: It is the only material in hard-on-hard bearings proven in arthroplasty that does not release toxic metal ions. Currently, two ceramic-on-ceramic hip resurfacing systems are being tested clinically for safety and efficacy.

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References Editorial

1. Gerhardt D, Mors TGT, Hannink G, Van Susante JLC. Resurfacing hip arthroplasty better preserves a normal gait pattern at increasing walking speeds compared to total hip arthroplasty. Acta Orthop. 2019;90(3):231-236. doi:10.1080/17 453674.2019.1594096.

2. Zhao HY, Kang PD, Xia YY, Shi XJ, Nie Y, Pei FX. Comparison of Early Functional Recovery After Total Hip Arthroplasty Using a Direct Anterior or Posterolateral Approach: A Randomized Controlled Trial. J Arthroplasty. 2017;32(11):3421- 3428. doi:10.1016/j.arth.2017.05.056.

3. Logishetty K, Rudran B, Cobb JP. Virtual reality training improves trainee performance in total hip arthroplasty: a randomized controlled trial. Bone Joint J. 2019;101-B(12):1585-1592. doi:10.1302/0301-620X.101B12.BJJ-2019-0643.R1.

4. Cobb JP, Kannan V, Brust K, Thevendran G. Navigation reduces the learning curve in resurfacing total hip arthroplasty. Clin Orthop Relat Res. 2007;463:90-97. doi:10.1097/BLO.0b013e318126c0a5.