11 Understanding the Clinical Performance of Ceramic Coated Femoral Components in Knee Arthroplasty Surgery

Abstract

Abstract Aim In vitro knee simulation has demonstrated favourable wear properties and decreased metal ion release of ceramic coated metal femoral components in total knee arthroplasty surgery. Femoral implants coated with ceramic have been used in patients, however the subsequent clinical performance and time-to-revision of these implants is largely unknown. The scope of this study was to review the current available clinical literature, focusing on retrieval studies of Ceramic-Coated TKAs. Method Literature review of PubMed and MEDLINE. All studies included demonstrated clinical evaluation of implant performance, either in vivo or at revision. Results 9 studies were identified and included for analysis in this study. Retrieval analysis has illustrated microscopic defects in coatings of revised implants, with associated abrasion and 3rd body wear of the polyethylene component. Evidence suggests that coating femoral components with ceramic can prevent effective cement bonding, leading to aseptic loosening and thus earlier implant failure. Despite these problems, high volume centres have been able to demonstrate comparable results when compared with traditional bearing surface combinations. The mechanism behind metal ion hypersensitivity is currently poorly understood; however, the use of ceramic coated knee replacements is demonstrating a reduction in metal ion release. Conclusions Whilst conferring favourable clinical properties in certain instances, the lack of surgical, implant and patient data surrounding the use of this coated implants remains concerning. The literature base remains limited, and meaningful clinical conclusions cannot be drawn. Recommendations include performing robust clinical trials in order to delineate the clinical efficacy of ceramic coatings in knee arthroplasty.