The growing number of hip and knee arthroplasty procedures in most OECD countries require solutions and adequate planning to reduce the future burden of disease and its economic consequences. A growing number of primary arthroplasties are performed on younger and more active patients, consequently this cohort will be at high risk for multiple revisions in their lifetimes. Since revision heavily affects the patient and the healthcare system, the use of implant systems with a lower risk for revision and the use of value-based payment models could be effective strategies for reducing healthcare expenditures in the long-term.
Tribological bearing couple represents one among the variables affecting outcomes after joint arthroplasty. The materials chosen must meet not only the properties required by the application, but also the highest quality, beyond just compliance, regardless of commercial demand. This necessitates continuous development of manufacturing technology, which in turn needs continuous research to deepen knowledge in the field of materials science. These are the necessary conditions to ensure the best clinical outcomes, reflected in a low incidence of revision and patient satisfaction.
With the introduction of the Zirconia, Platelet-toughened Alumina (ZPTA) with brand name BIOLOX®delta by CeramTec GmbH (Plochingen, Germany) in 2003, ceramic components have established themselves as durable bearings in hip arthroplasty and become the preferred material on the head side in many countries worldwide. Current best available evidence suggests indeed a favorable long-term benefit-risk-ratio of ZPTA bearings. International joint registries also give strong indications that ceramic composite or mixed ceramic bearings in THA are associated with a lower overall risk of revision, mainly driven by a lower risk of revision for periprosthetic joint infection than the other bearing choices, probably the most serious complication in total joint arthroplasty.
This relentless dedication to improvement of the material knowledge provides the possibility of its use in other applications. For example, ceramic could also become the (bio-)logical alternative in hip resurfacing. Last, ceramic knee arthroplasty implants made of BIOLOX®delta have been introduced in the EU market since 2006. The FDA recently confirmed (2022) the knee replacement device of CeramTec made of BIOLOX®delta ceramic meets the criteria of a Breakthrough Device.