Ceramics are widely used in orthopaedics due to their biocompatibility and mechanical properties. Ceramics are classified as bioinert, bioactive, or biodegradable based on how they interact with the body. Bioinert ceramics like alumina and zirconia are used for joint replacements due to their strength and wear resistance. Bioactive ceramics like hydroxyapatite and bioglass bond to bone and are used as bone grafts or coatings. Biodegradable ceramics like calcium phosphates degrade and are replaced by bone, making them suitable for drug delivery or bone voids. Ceramics have advantages for orthopaedic applications but also

1. CERAMICS IN ORTHOPAEDICS
PRESENTER: DR. CH. RAKESH SINGHA
2nd Year PGT
Dept of Orthopaedics, SMCH

2. INTRODUCTION
• Biomaterial is defined as natural or synthetic substances capable of being tolerated
permanently or temporarily by the human body.
• Ceramics are one of them.
• Ceramics are inorganic metallic, semi-metallic or non-metallic solid materials with
varying composition.

3. • Bioceramics are ceramic material developed for use in medical implants like hard
tissue.
• The bioactivity of the material can be defined as its ability to bond biologically to
bone.
• Bioceramics have played integral roles in treatment modalities for damaged &
disease human joints & osseous defects.

4. PROPERTIES OF CERAMIC MATERIALS
• Highly inert.
• Hard but Brittle.
• High compressive state.
• Good electric & thermal insulator.
• Good aesthetic appearance.
• They are lighter than metals.

5. Ceramics used in Biomedical Application

6. BIOMATERIAL CLASSIFICATION
• First generation :
- Bioinert material
• Second generation :
- Bioactive & Biodegradable material
• Third generation :
- Material designed to stimulate specific response at molecular
level.

7. FIRST GENERATION
• Invented in 1980
• Bioinert – minimum immune
response & minimum foreign
body reaction
• Same physical properties to
match replaced tissue.

8. SECOND GENERATION
• Invented between 1980 – 2000
• Interacts with biological
environment.
• Bioactive – it enhances biological
response & tissue surface
bonding.
• Biodegradable – it undergoes
progressive degradation with
healing & regeneration of tissue.

9. THIRD GENERATION
• Invented in 2002
• AIM is to stimulate specific
cellular response at molecular
level
• Signal & stimulate specific
cellular activity.

10. CLINICAL APPLICATION OF ORTHOPAEDIC
IMPLANT
• Osteosynthesis
• Joint replacement
• Nonconventional modular tumor
implant
• Spine implant

11. IDEAL IMPLANT MATERIAL
• Chemically inert
• Non toxic to the body
• Great strength
• High fatigue resistance
• Low elastic modulus
• Absolutely corrosive proof
• Good wear resistance
• inexpensive

12. COMMON IMPLANT MATERIALS
METAL ALLOYS
• Stainless steel
• Titanium alloys
• Cobalt chrome alloy
NONMETAL
• Ceramics & Bioactive glass
• Polymers (Bone cement,
polyethylene)

13. BIOMATERIAL USED IN ORTHOPAEDICS
A) METAL & METAL ALLOYS
B) CERAMICS
C) TISSUE ADHESIVES
D) BONE REPLACEMENT MATERIAL
E) CARBON MATERIAL & POLYMERS

14. A) METALS & METAL ALLOYS
1) STAINLESS STEEL:
• Composition :
- Iron
- Chromium
- Nickel
- Molybdenum
- Carbon
• Most commonly used is 316L
- 3%M, 16%Nickel, Low carbon

15. Advantages
• Relatively ductile
• Biocompatible
• Relatively cheap
• Reasonable corrosion resistance
• Strong
Disadvantages
• Poor wear resistance
• Stress shielding of surrounding
bone & bone resorption
• High Youngs modulus

16. 2) TITANIUM
Contains:
- Titanium (89%)
- Aluminium (6%)
- Vanadium
• Most commonly used is Titanium 64

17. Advantages
• Corrosion resistance
• Excellent biocompatibility
• Ductile
• Low Young’s modulus
• MR scan compatibly
• Osseointegration
Disadvantages
• Poor wear characteristics
• Systemic toxicity – vanadium
• Relatively expensive

18. 3) COBALT CHROME ALLOYS
• Contains primarily Cobalt (30-
60%)
• Chromium is added to improve
corrosion resistance
• Usually used for bearing surfaces
in THR.

19. Advantages
• Excellent resistance to corrosion
• Excellent long term
biocompatibility
• Very strong
Disadvantages
• Very high Young’s modulus
• Risk of stress shielding
• expensive

20. 2) CERAMICS
• Compounds of metallic elements
bound ionically or covalently
with nonmetallic elements.
• Common ceramics are:
- Aluminium
- Silica
- Zirconia
- Hydroxyapatite

21. • Ceramics are refractory polycrystalline compounds
- usually inorganic
- highly inert
- hard & brittle
- high compressive strength
- generally good electric & thermal insulator.

23. 1) ALUMINA ( inert ceramic)
• Better wear resistant with
stainless steel
• Application :
-femoral head
-bone screw & plates
-porous coating for femoral
stems
-knee prosthesis

24. 2) ZIRCONIA (inert ceramics)
Obtain from zircon
Application :
- femoral head
-artificial knee
-bone screw &nplates

25. 3) BIOGLASS (bioactive)
Made up of calcium phosphates
USES OF BIOGLASS:
1. Bone-graft material
2. Drug delivery system
Drugs which have been used-
Teicloplanin
Vancomycin
Condition where used-
OSTEOMYELITIS

26. 4) CALCIUM PHOSPHATES
(biodegradable ceramics)
Uses :
- Repair material for damaged
bone
- Void filling after resection of
bone tumor
- Repair & fusion of vertebrae
- Repair of herniated disc

27. c) TISSUE ADHESIVE
• Properties:
-Moderately viscous (spread
easily)
-Ability to degrade at a
appropriate rate
-Biocompatibility
• Commonly used are
- Fibrin gel, Albumin &
mucopolysaccharides.

28. CARBON MATERIAL & POLYMERS
1) CARBON FIBRES:
application-
- Total hip replacement
- Internalfixation for fractures
- Spine surgeries
Disadvantages:
- Release of carbon debris in to
the surrounding medium.

29. 2)PMMA
The powder contains:
- PMMA copolymer
- Barium oxide(radio opacifier)
- Benzoyl peroxide ( catalyst)

30. • Stages of cement rection:
- Dough time 2-3mints
- Working time 5-8mints
- Setting time 8-10mints
• Mainly used to fix prosthesis in
place can also be used as void
fillers
• Available as liquid & powder

31. Advantages
• Tough
• Ductile
• Resilient
• Resistant to wear
Disadvantages
• Susceptible to abrasion
• Thermoplastic
• Weaker than bone in tension

32. 3) UHMWPE
-A polymer of ethylene with MW
-Metal on polyethylene has high
success rate in bearing surface in
THR
- Used for acetabular cups in THR
prosthesis & tibial components in
TKR

33. GENERAL TISSUE-IMPLANT RESPONSES
• All implant material elicit some response from the host
• The response occurs at tissue-implant interface
• Response depends upon-
- type of tissue
- mechanical load
- amount of motion
- composition of the implant
- age of patient

34. COMPLICATION
1) ASEPTIC LOOSENING
- Caused by osteolysis from body’s
reaction to wear debris
2) STRESS SHIELDING
- Implant prevents bone from
being properly loaded
3) CORROSION
- Reaction of the implant with its
environment resulting in its
degradation to oxides.

35. 4) INFECTION
5) METAL HYPERSENSITIVITY
6) MANUFACTURING ERRORS

36. CERAMICS USED IN ORTHOPAEDIC SURGERY
ARE CLASSIFIED AS:
1) BIOINERT CERAMICS
• 1ST generation ceramics.
• Incorporate into bone in accordance with pattern of contact osteogenesis.
• Maintain Same physical and mechanical properties with living tissue.
• ALUMINA CERAMIC (AlO3)
• ZIRCONIA CERAMIC (ZrO3)
• ZIRCONIA TOUGHENED ALUMINA (ZTA) CERAMIC,
• OXINIUM MATERIALS (OXIDISED ZIRCONIUM)

37. 2) BIOACTIVE CERAMICS
• 2ND generation ceramics.
• Capable of chemical bonding with living tissues (bonding osteogenesis).
• Osteoconductive and osteoinductive as it can promote bone formation both along
and within bone-implant interface.
• HYDROXYAPATITE (which has been sintered at high temperature)
• BIOACTIVE BIOGLASS
• BIOACTIVE BONE CEMENTS

38. 3. BIORESORBABLE/ BIODEGRADABLE CERAMICS
• 2nd generation ceramics
• Gradually absorbed in vivo and replaced by bone in the bone tissue.
• Similar to contact osteogenesis.
• Undergo progressive degradation with healing and degeneration of tissues
upon implantation.
• CALCIUM PHOSPHATES
• TRICALCIUM PHOSPHATES
• HYDROXYAPATITE (which has been sintered at low temperature)

39. APPLICATIONS OF BIOCERAMICS IN ORTHOPAEDICS
SURGERY

40. JOINT ARTHROPLASTY

41. JOINT ARTHROPLASTIES
• JOINT REPLACEMENT COMPONENT- FEMORAL HEAD, STEM
• THR ACETABULAR INLAYS
• THR CONDYLES
• KNEE PROSTHESIS
• SMALL JOINT PROSTHESIS
BIOCERAMICS APPLIED-
a. ALUMINA CERAMICS
• Better wear resistant with stainless steel or Co-Cr alloy
• Alumina with metal articulating against polythene shows less wear for the
polythene wear.
• Modern alumina has shown to have lower toughness than old alumina
even though with less impurities than old alumina.

42. b. ZIRCONIA CERAMIC (ZrO2)
• Has been Introduced because its One of the strongest
ceramics to reduce the risk of fracture
• Superior wear resistance with smoother finish
• Favoured over UHMWPE due to superior wear resistance
• HOWEVER ZARCONIA HEADS SHOULD ARTICULATE ONLY
AGAINST POLYTHENE SOCKETS
c. ZIRCONIA TOUGHENED ALUMINA(ZTA) CERAMIC
• Mixed oxide ceramics of 75% alumina, rest zirconium,
ytrrium and chromium oxides
• Superior strength AND resistance to wear
• Better wear compared to alumina ceramics in vitro
• Hip joint stimulator shows promising results

45. COATING OF IMPLANTS
a. ALUMINA CERAMICS
Coating of IMPLANTS like metallic hip prosthetic stems and small
joint prosthesis
b. OXINIUM MATERIALS (OXIDISED ZIRCONIUM)
It is a Thin layer of Zirconium oxide coated on the surface of the
solid zirconium metal
• Provides Combined effects of METAL AND CERAMIC TO IMPLANTS
• Here too,femoral head made of oxinium articulates with a
polythene cup

46. c. SYNTHETIC HYDROXYAPATITE-
• It is brittle and undergoes slow resorption and give mechanical
stress
• So it is modified and combined with other materials for improved
outcome and faster resorption
• Synthetic HP administered
by means of plasma sprays

47. BONE-GRAFT SUBSTITUTE
1. ALUMINA CERAMIC
2. ZIRCONIA CERAMIC
3. HYDROXYAPATITE
• Chosen because it has most similar structure to mineral component of
bone
4. BIO-GLASS CERAMICS
5. BIOACTIVE CALCIUM PHOSPHATE BASED BONE CEMENTS
• ETEX alpha-BSM
6. TRICALCIUM PHOSPHATE

48. SPINAL SURGERY
CONDTIONS LIKE REPAIR AND FUSION OF VERTEBRAE
REPAIR OF HERNIATIC DISCS
BIORESORBABLE / BIODEGRADABLE CERAMIC
1. TRICALCIUM PHOSPHATE HAS BEEN SHOWN TO SHOW
COMPARABLE RESULTS TO THOSE WITH AUTOGENOUS
BONE.
• BETA TRICALCIUM PHOSPHATE IS AVAILABLE IN
INJECTABLE FORM
2. CALCIUM PHOSPHATES

49. BIOACTIVE GLASS CERAMICS
• Hard , non-porous materials of Calcium, Phosphorus and Silicon dioxide
• Osteointegrative and osteoinductive properties
• It allows growth of new bone material along and within the bone-
implant interface
• Bioglass possess and interconnective porous system and bioactivity of
its surface enables the growth of osseous tissues
• Incorporation of stainless steel is shown to increase the binding
strength
NAMES OF BIOGLASS CERAMICS:
1.BIO GLASS 45S5 / Calcium sodium phosphosilicate
2.BIO GLASS WOLLASTONITE

50. • BIO GLASS 45S5 HAS GREATER PRODUCTION OF BONE COMPARED WITH
SYNTHETIC HYDROXYAPATITE.
USES OF BIOGLASS:
1. Bone-graft material
2. Drug delivery system
Drugs which have been used- Teicloplanin
Vancomycin
Condition where used- OSTEOMYELITIS
4. Bone tissue engineering
5. Wollastonite is also used as a spacer at the iliac crest,
vertebral prostheses

51. BIOACTIVE BONE CEMENT
• Explored in order to avoid complications related to
PMMA debris
• To enhance fixation of the prosthesis
NAMES OF BIOACTIVE BONE CEMENT INTRODUCED:
1. Calcium-phosphate based bone cement
2. Glass-ceramic bone cement

52. DRUG DELIVERY SYSTEM
CONDITIONS USED-
• FILLING OF BONE CYST
• BONE LESIONS
• CAVITARY OR SEGMENTAL BONE LESIONS
• INFECTIONS

53. 1. CALCIUM PHOSPHATE BASED BONE CEMENTS
• Bioactive, biocompatible and Bioresorbable bone
cement
• It is bioresorbable after 12 weeks
• Used as BONE VOID FILLER
• They are available in INJECTABLE FORM
• They are used as DRUG DELIVERY SYSTEM.
NAME OF BONE CEMENTS INTRODUCED:
• N-SRS
• ETEX alpha- BSM

54. N- SRS / NORIAN SKELETAL REPAIR SYSTEM
• Combination of monocalcium phosphate, tricalcium phosphate, calcium
carbonate and
sodium phosphate solution
USES:
• Augementation of fracture repair like
• Dynamic HIP SCREW FIXATION, Pedical screw fixation.
ETEX ALPHA BSM
• It is Calcium orthophosphate cement
USES:
• Bone graft substitute

55. OSTEOSET
• Composed of Calcium sulphate and Aminoglycosides
• Provides structural support to the bone defects
• Bio absorbable and biocompatible
• IT IS AVAILAvLE IN PELLETS.
USES:
• Bone-graft substitute
• As Drug delivery system, eg. AMINOGLYCOSIDE (tobramycin)
• USED IN OSTEOMYELITIS OF TIBIA

56. CONCLUSION
THE EXCELLENT BIOCOMPATIBILTY AND OUTSTANDING
PROPERTIES OF BIOCERAMICS HAVE ENCOURAGED THEIR USE AS
BEARINGS IN JOINT REPLACEMENT.
IMPROVEMENT IN THE MANUFACTURING PROCESS HAS
ALLOWED THE PRODUCTION OF RELAIBALE MATERIALS
CERAMIC COATINGS PROVIDE AN ATTRACTIVE ALTERNATIVE FOR
BIOLOGICAL FIXATION.

57. •THANK YOU