This document discusses recent advances in using ceramics in orthopaedics. It describes different types of ceramics used, including bioinert, bioactive, and bioresorbable ceramics. Bioinert ceramics like alumina and zirconia are used in joint replacements due to their strength and wear resistance. Bioactive ceramics like hydroxyapatite bond with bone and are used in bone grafts and coatings. Bioresorbable ceramics like calcium phosphates degrade and are replaced by bone. Applications include joint replacements, coating implants, and filling bone defects. The excellent biocompatibility of ceramics has encouraged their use in orthopaedics

1. RECENT ADVANCES IN
CERAMICS IN ORTHOPAEDICS
DR BIPUL BORTHAKUR
PROFESSOR & HOD
DEPT. OF ORTHOPEDICS
SILCHAR MEDICAL COLLEGE AND HOSPITAL

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

4. BIOCERAMICS ARE CERAMIC MATERIALS DEVELOPED FOR USE IN
MEDICAL IMPLANTS LIKE HARD TISSUE LIKE BONES.
THE BIOACTIVITY OF THE MATERIAL CAN BE DEFINED AS ITS ABILITY
BOND BIOLOGICALLY TO A BONE.
BIOCERAMICS HAVE PLAYED INTEGRAL ROLES IN TREATMENT
MODALITIES FOR DAMAGED AND DISEASES HUMAN JOINTS AND
OSSEOUS DEFECTS.
BIOCERAMICS AND COATINGS ARE EXPECTED TO HAVE INCREASING
USE IN ORTHOPAEDICS BECAUSE OF THEIR UNIQUE COMBINATION
AND RANGE OF PROPERTIES.

6. CERAMICS USED IN ORTHOPAEDIC SURGERY
ARE CLASSIFIED AS:
I. 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)

7. 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
within bone-implant interface.
 HYDROXYAPATITE (which has been sintered at high temperature)
 BIOACTIVE BIOGLASS
 BIOACTIVE BONE CEMENTS

8. 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)

9. APPLICATIONS OF
BIOCERAMICS IN
ORTHOPAEDICS
SURGERY

10. JOINT ARTHROPLASTY

11. 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.

12. 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

16. 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

17. 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

18. 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

21. 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

22. BIOACTIVE CERAMICS
 As a spacer in –
 Iliac crest
 Intervertebral spacer
 Laminoplasty spacer

23. 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

24.  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

25. 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

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

27. 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

30. 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

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

34. 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.

35. THANK YOU