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 # 12022


Guest Editor

Javad Parvizi MD,
FRCS Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia, PA

Combating Infection: The Role of Implant Materials in Orthopedics and Dentistry


In 1952, the Swedish anatomy professor Per-Ingvar Brånemark was investigating as young researcher the anatomy of blood flow. One of his experiments studying the microcirculation in rabbit bone tissue resulted in the discovery of osseointegration and the beginning of implantology. Our colleague’s original intention was to apply this finding to joint replacement, but then he turned his back on orthopaedics and dedicated his research to dental implantology.


It took a while before his research allowed a breakthrough. Still in 1974, the American Dental Association suggested that dental implants should not be used for routine clinical practice! History taught us that perseverance would reward Prof. Brånemark‘s efforts. Today, dental implantology records excellent outcomes, similar to what we see in hip or knee replacement. Together with this success, though, we also share a common enemy: bacteria.


Whereas orthopaedic surgeons fight against periprosthetic joint infection in hip and knee arthroplasty, dental implantologists face peri-implantitis and oral mucositis. Both disciplines can learn from each other in the battle against infection and understand the association between implant materials and host response.


Prof. Lia Rimondini is an expert in development and pre-clinical characterization of implantable biomaterials. As part of her research field, she explored the role of bacteria and biofilm formation on dental implant materials. She extended her research to orthopaedic implant materials and could confirm what she had discovered for oral implants: bacteria are generally more prone to adhere to metal than to ceramics. In other words, ceramics accumulate less biofilm than metal or even polymers. In her contribution Prof. Rimondini compares the behavior of bacteria and biofilm formation in both body regions.


Prof. Romanos is an implantologist and professor of dentistry. Routinely, he has long used titanium implants. Like many of his colleagues, he faces a high prevalence of inflammatory processes after implanting titanium implants. He has dedicated his life to investigating the mechanisms causing peri-implantitis and peri-implant mucositis. As in orthopaedics, the reasons are multifactorial. However, the advances in ceramic implantology and the improvement of ceramic materials convinced him that using ceramic could cause less plaque formation and less inflammation around zirconia implants. Current studies support his observations.


At Rothman, we routinely use ceramic heads in total hip replacement because our research has shown the impact of material on the risk of infection. At our institution, we compared the infection rates of our patients treated with metal-on-polyethylene (MoP) to those treated with ceramic-on-polyethylene (CoP) implants. Our findings, recently published in the Journal of Orthopaedic Research, show a significantly higher incidence of infection in patients with metal heads. We suspect that the reasons are multifactorial, but a specific mechanism related to leucocyte recruitment to metal implants can be an explanation.


More than ever, nurturing an interdisciplinary research culture with solid bonds between basic research and clinical research appears to be the key to understanding our patients and their comorbidities, and selecting adequate treatment for them.

Outcomes Research

Reducing the risk of postoperative infection with ceramic in THA

Earlier studies suggest that metal heads are associated with an increased rate of revision for PJI. The causal relationships or mechanisms of infection with metal bearings surfaces are not yet fully understood. A recently published study by the research team led by J. Parvizi MD, FRCS, aimed to investigate this relationship, using prospectively collected data from Rothman Institute internal total hip replacement database.

Implant Material

Bacteria and Biofilm Formation on Biomaterials

Fighting bacteria and infection is a concern that orthopedic surgeons and implantologists have in common. Bacteria strains and biofilm dynamics may differ, but the basic processes are the same. Microbial biofilm naturally adheres to implant surfaces. Research led by Prof. L. Rimondini at Università del Piemonte Orientale “A. Avogadro”, brought a huge contribution to understand the mechanisms of interaction of bacteria with implant surfaces.

Outcomes Research

Peri-implantitis: Definition, Treatment and Implant Material-Associated Metallosis

Like orthopedic surgeons, dental implantologists fear the pathogenic bacteria, which lead to peri-prosthetic joint infection in orthopedics or in case of oral implants to an overreaction of the immune system leading to peri-implantitis. Prof. Dr. G. Romanos, periodontist at Stony Brook University, NY, shares more insights about this destructive inflammatory process in the oral cavity and possible association with the implant material.

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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.