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Background Whilst bony fixation of hip replacement has stable solutions, there remains controversy over which bearing best optimizes longevity and function. Ceramic-on-ceramic (CoC) bearing combinations are associated with lower risk of revision due to aseptic loosening and dislocation. Evidence for long-term functional outcomes of modern, 4th generation CoC bearings is limited. The aim of this study was to analyze outcomes and complications of the R3™ Acetabular System (Smith & Nephew, Inc., Cordova, TN, USA) in combination with BIOLOX® Delta ceramic femoral head in patients undergoing primary total hip arthroplasty (THA). Methods Between June 2009 and May 2011, 175 patients (178 hips) were enrolled into a prospective, study at 6 sites in Europe and prospectively followed-up at 3 months and 1, 3, 5, and 7 years postoperative. Results Total WOMAC score improved from 63 (range, 22–91) preoperative to 8 (range, 0–8) at 1-year follow-up and remained unchanged at 7-year follow-up. Modified Harris hip score improved from 45 (range, 10–87) preoperative to 83 (range, 25–100) at 3 months, 91 (range, 42–100) at 1 year, and 92 (range, 46, 100) at 7 years. UCLA Activity Rating Scale score improved from 3.3 (range, 1–8) preoperative to 6.2 (range, 2–8) at 1 year; it marginally declined to 5.8 (range, 3–8) at 7-year follow-up. There were 4 trochanteric fractures and 5 patients died of unrelated reasons. Three hips were revised (2 periprosthetic fractures and 1 subluxation). The 7-year cumulative survival rate was 98.3%. Conclusion Clinical and functional improvements of THA with CoC bearing are maintained at 7 years postoperative. Trial registration ClinicalTrials.Gov, NCT03566082 , Registered 10 January 2018—retrospectively registered,

BackgroundThe results of total hip arthroplasty (THA) with use of Delta ceramic articulation were successful at medium term follow-up. The use of this newest ceramic has markedly reduced the incidence of ceramic head fractures, but not the incidence of ceramic liner fractures. We tested a hypothesis that the ceramic fractures are prevented by use of a metal shell with 18° inner taper angle and a stem design with a reduced neck geometry.MethodsWe conducted a prospective multicenter study of cementless THA with use of 32/36-mm Delta ceramic bearing, Exceed ABT metal shell and Taperloc stem. We evaluated ceramic fracture, noise, clinical results, radiological changes and survival rate at a minimum of 5-year follow-up.ResultsFrom April 2010 to February 2012, 246 patients (274 THAs) were enrolled. Among them, 224 patients (130 men and 94 women, 250 hips) were followed-up for 5–8 years (mean 6.0 years). Ceramic malseating or fracture did not occur in any patient. Eight patients (8 hips, 3.2%) reported noise. Mean Harris hip score was 84 points at the latest follow-up. All acetabular and femoral components had bone-ingrown stability. Two hips were revised due to recurrent dislocation and periprosthetic fracture. The survival rate was 99.6% at 8 years postoperatively.ConclusionCeramic fractures can be prevented by a use of (1) 32/36-mm Delta ceramic bearing, (2) metal shell with 18° taper angle, and (2) stem with a reduced neck geometry. However, noise remains a concern of the Delta ceramic bearing.Level of evidenceTherapeutic level II.

IntroductionForte ceramic head on delta ceramic liner articulation showed satisfactory midterm results without ceramic-related complication. We aimed to investigate the clinical and radiological outcomes of cementless total hip arthroplasty (THA) with forte ceramic head on delta ceramic liner articulation.Materials and methodsOverall, 107 patients (57 men, 50 women; 138 hips) who underwent cementless THA with forte ceramic head on delta ceramic liner articulation were enrolled. The mean follow-up duration was 11.6 years. For the clinical assessments, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), presence of thigh pain, and presence of squeaking were evaluated. Radiographs were assessed to search for osteolysis, stem subsidence, loosening of implants. Kaplan–Meier survival curves were evaluated.ResultsThe mean HHS and WOMAC improved from 57.1 and 28.1 preoperatively to 81.4 and 13.1 at the final follow-up, respectively. Nine revisions (6.5%) were performed; 5 hips for stem loosening, 1 hip for ceramic liner fracture, 2 hips for periprosthetic fracture, and 1 hip for progressive osteolysis around cup and stem. Thirty-two patients (37 hips) complained squeaking, in which 4 cases (2.9%) were identified as ceramic-related noises. After a mean follow-up period of 11.6 years, 91% (95% CI 87.8–94.2) were free from revision of both femoral and acetabular components due to any reason.ConclusionsCementless THA with forte ceramic-on-delta ceramic articulation showed acceptable clinical and radiological results. Serial surveillance of these patients should be performed due to the possibility of cerami- related complications such as squeaking, osteolysis, and ceramic liner fracture.

Introduction: A modular head–neck adapter system may help surgeons restore the proximal hip biomechanics in revision hip arthroplasty. However, the clinical and radiographic 5-year outcomes of the system are still scarcely reported. The aim of this study is the assessment of (1) complications and survival rates, (2) clinical and (3) radiological outcomes of the modular head–neck adapter system with a ceramic head in revision hip arthroplasty at 5 years. Methods: 32 revision hip arthroplasties using a modular head–neck adapter system and a ceramic head were retrospectively recorded. Preoperative demographic and implant features were collected. Clinical and radiographic outcomes, failures and reasons for re-revisions were recorded at the last follow-up. Results: A mean follow-up of 59.8 ± 26 months was achieved. The survival rate was 90.6% at 5 years. Post-operative complications occurred in nine cases (28.1%): two dislocations (6.2%), one aseptic cup loosening (3.1%) requiring re-revision, one (3.1%) persistent pelvic pseudotumor requiring embolization. No mechanical failures of the adapter or ceramic head occurred. The mean post-operative HHS score was 84.4 points. Thirteen cases (40.6%) showed optimal radiographic cup osseointegration, and 17 hips (53.1%) showed valid stem osseointegration. The mean post-operative femoral offset was 48.84 mm, larger than the contralateral side (p = 0.02). The post-operative lateralization of the hip joint was 38.09 mm, close to the contralateral side (p = 0.4). Conclusions: In revisions, the modular head–neck adapter system with ceramic head provided good clinical outcomes and acceptable radiographic reconstruction of hip biomechanics, with a survival rate of 87.9% at 5 years.

Purpose There are limited reports for the results of the fourth-generation ceramic-on-ceramic (CoC) articulation total hip arthroplasty (THA). And, throughout the surgical experience, we encountered some cases of liner pulling-out phenomenon after liner fixation and femoral preparation. The objective of this study was to evaluate the incidence, risk factors of delta ceramic liner or head fractures, and also the clinical and radiological results of using the fourth-generation CoC articulation in THA. Patients and Methods We retrospectively reviewed 242 patients (263 hips) who underwent primary THA using the fourth-generation CoC articulation with a minimum followup of 2 years. Demographic data, Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Patient’s satisfactory level were recorded. The radiological evaluation was used to evaluate the implant fixation and complications. Mean followup duration was 5.2 years. Results Mean HHS and WOMAC score were significantly ( P < 0.05) improved at the last followup. About 98.5% of the patients were satisfied with results of the surgery. All acetabular components were placed in adequate position and there was no osteolysis on acetabular or femoral components and subsidence of femoral stem. Four patients showed complications including one-liner fracture. Conclusion Our midterm study demonstrated excellent clinical and radiological results with only one ceramic liner fracture. Moreover, the results of this study indicate that one possible cause of pulling-out phenomenon is the resonance effect during implantation in Dorr type A patients with the thick cortex. If the surgeon is aware of the liner malposition throughout the operation, the fourth-generation CoC articulation THA could be an outstanding treatment.

There is a rising concern about squeaking in ceramic-on-ceramic total hip arthroplasty (THA). In pin-on-disc testing of a delta–delta coupling, we reproduced squeaking and observed microcracks on worn surfaces. We used a pin-on-disc machine and made discs and pins by cutting delta ceramic to a diameter of 40 mm (D–D). Cross-linked polyethylene was used for a comparison disc (D–P). We performed the same test using another D–D coupling specimen to confirm reproducibility. Squeaking in the D–D specimen was reproduced in wet conditions, though it was not found in the D–P specimen. Fast Fourier transform analysis showed a peak frequency for squeaking of 2794 Hz. The noise occurred at about 6.6 km of sliding distance. Scanning electron microscopy revealed that the worn surface of the pin in D–D at 10.8 km of sliding distance had some microcracks. However, there was no obvious damage to the worn surface of the pin in D–P at the same sliding distance. We confirmed the reproducibility of these findings, obtaining similar results, including squeaking, from another D–D coupling specimen. Our findings show that squeaking may occur in THA using delta ceramic bearings even if implants are placed to avoid extra-articular impingement of the femoral neck. Although the clinical relevance of microcracks is unknown, they may affect long-term outcomes in THA using delta ceramic bearings.

Ceramic-on-ceramic (COC) total hip arthroplasties (THAs) with large heads (>36 mm) were introduced to reduce dislocation rates and restore the hip anatomy as closely as possible to the native one. To date, the literature is scarce and fragmented; a review is desirable to point out the outcomes and the possible specific complications (noise, groin pain, and taperosis). A systematic review about large-diameter COC THAs was conducted according to the PRISMA guidelines. The PubMed and Cochrane databases were searched using the terms “large”, “big”, “head”, “hip”, and “ceramic.” The methodological quality of the papers was assessed using the MINORS (Methodological Index for Nonrandomized Studies) score. Seven papers (level of evidence: 5 case series and 2 case-control studies) met the inclusion criteria. Clinical outcomes were excellent in >90% of the patients. Groin pain was reported in only 1 article (7%). Radiological outcomes were positive. Minimal revision rates (<2%) were reported at short- to mid-term follow-ups. Dislocation rates were usually <1%. No bearing surfaces failed. No case of trunnionitis was reported. Noise occurred in up to 30% of the patients, mostly squeaking. The noise did not influence clinical outcomes or patients’ satisfaction. Noise was inconstantly associated with component positioning, younger age, high articular excursions, and larger sizes. Large-diameter heads in COC THAs (≥40 mm) showed promising clinical and radiological outcomes with minimal revision rates. Noise is a cause of concern and should be carefully evaluated at longer follow-ups and in larger, prospective, and specifically designed case series.

Herein, we report the synthesis of Dy–V co-doped Bi 2 O 3 ceramics using the solid–state processing technique under atmospheric conditions. The X-ray diffraction (XRD) patterns demonstrate the stability of the cubic fluorite δ -Bi 2 O 3 in the V-rich ceramics. However, in Dy-rich ceramics, a mixture of phases, including α and δ , gradually diminishes with increased mutual dopant concentrations, suggesting a transition to the single fcc δ -phase with Fm -3  m space group. According to the Rietveld analysis and electron density representation, it is evident that there are no impure peaks present in α -Bi 2 O 3 , which highlights the clear transition to the δ -phase polymorphs. The DTA curves for samples M4 and M7 display a distinct endothermic peak at temperatures around 724.5 and 744.5 °C, indicating a phase transition from the monoclinic α-phase to the cubic δ -phase. These peaks are also attributed to an order-disorder transition (ODT). The FESEM micrographs consistently revealed the existence of irregular and aggregated grains, with an average grain size ranging from 0.80 to 5.57 μm. The level of aggregation became more apparent with the escalation of Dy 3+ doping, as opposed to the 5–20 wt% V loading. Moreover, the as-sintered pellets M2 demonstrated the absence of any pore formation compared to other samples, confirming a remarkably high degree of densification. As a result, the as-sintered pellets have a low level of void space, with an apparent porosity of no more than 2.5%. Based on the conductivity measurements and electrochemical impedance spectroscopy (EIS), Bi 0.85 V 0.10 Dy 0.05 O 1.5 exhibits the highest electrical conductivity of 0.965 (Ω cm) −1 and an optimal activation energy of 0.537 eV at 627 °C compared to other prepared compositions. This remarkable performance is attributed to the high polarizability and mixed valence cations, especially in V 5+ -rich ceramics, compared to the Dy 3+ -rich compositions with a reduced conductivity of 0.010 to 0.097 (Ω cm) −1 . The Nyquist plots indicate that impedance decreases with vanadium doping increases until it reaches Bi 0.85 V 0.10 Dy 0.05 O 1.5 . Higher Dy 3+ content increases impedance, leading to lower cell performance. The typical composition can be a solid electrolyte in SOFCs operating at moderate temperatures.

Background: To identify and compare the shade variations of various commonly used esthetic dental ceramics by calculating their total-color-difference (ΔE) and translucency parameter (TP) using a spectrophotometer. Methods: In total, 165 disc specimens from three shades (A1, B1, and C1) of five ceramic materials (N = 55/shade; n = 11/ceramic material group) were prepared (Metal-ceramic (MC), IPS e.max press (Emax-P), IPS e.max layer (Emax-L), Layered Zirconia (Zr-L) and Monolithic zirconia (Zr-M)). With a spectrophotometer, the L* a* b* values were obtained. Total color differences (ΔE = [(ΔL*)2 + (Δa*)2 + (Δb*)2]1/2) and translucency parameter (TP = [(L*B − L*W)2 + (a*B − a*W)2 + (b*B – b*W)2]1/2) were calculated. The statistical tests included ANOVA and Post hoc Tukey’s analysis (p < 0.05). Results: Significant differences (p = 0.000) were found between the groups for ΔE. Highest ΔE (A1) were found for Zr-L (80.18 ± 20) and lowest for Zr-M (62.97 ± 1.28). For B1, highest ΔE values were noted for MC (76.85 + 0.78) and lowest for the Emax-L (62.13 ± 1.49). For C1, highest ΔE values were found for the MC group (73.96 ± 0 67) and lowest for Emax-P (55.09 ± 1.76). Translucency variations between tested ceramics were revealed (p < 0.05). Highest TP values (A1) were found for Emax-L (2.99 ± 1.64) and lowest for Zr-L (0.35 ± 0.16). For B1, highest TP values were noted for Emax-P (3.50 ± 1.74) and lowest for MC (0.57 ± 0.40). For C1, highest TP values were found for Emax-P (4.46 ± 2.42) and lowest for MC (0.58 ± 0 48). Conclusions: Significant differences in ΔE and TP were found for tested ceramic groups. The color differences of the tested materials varied according to clinical acceptability, even with the selection of same color/shade. The color/shades of the various dental ceramics do not match with the vita shade guide tabs, to which they are compared most often. Shade differences are present between different lots of ceramic materials from the same or different brands.

Objective: The aim of the present in vitro study was to explore the differences in color matching of most frequently used shades for metal ceramic dental restorations fabricated by different laboratories. Materials and Methods: A total sample size of 180 discs of metal ceramic were prepared by six laboratories (labs): each lab prepared 30 samples, 10 for each shade (A1, B1, and C1). Instructions for standardization were provided. A spectrophotometer and CIE LAB system was used to find ΔE value for difference between shades observed by spectrophotometer. For statistical analysis, ANOVA and post hoc Tukey tests were used. Significance level was <0.05. Results: Significant variation (p = 0.000) was observed among the labs for ΔE. The maximum value for ΔE in shade A1 was 77.0 ± 0.065 and minimum value for ΔE noted for shade A1 was 69.19 ± 1.39. The values of ΔE for shade B1 were maximum 80.14 ± 0.16 and minimum 68.38 ± 0.40 and the values of ΔE for shade C1 were maximum 80.16 ± 0.14 and minimum 71.62 ± 1.23. Twelve out of 15 comparisons between labs for shade A1, 14 of 15 comparisons for shade B1, and 11 of 15 comparisons for shade C1 showed significant difference (p = 0.000). Conclusions: Similar tooth shades (A1, B1, and C1) when duplicated by different labs exhibited highly significant color variations.