Ceramics used for the repair and reconstruction of diseased or damaged parts of the musculo-skeletal system, termed bioceramics, may be bioinert (alumina, zirconia), resorbable (tricalcium phosphate), bioactive (hydroxyapatite, bioactive glasses, and glass-ceramics), or porous for tissue ingrowth (hydroxyapatite-coated metals, alumina). Applications include replacements for hips, knees, teeth, tendons, and ligaments and repair for periodontal disease, maxillofacial reconstruction, augmentation and stabilization of the jaw bone, spinal fusion, and bone fillers after tumor surgery. Carbon coatings are thromboresistant and are used for prosthetic heart valves. The mechanisms of tissue bonding to bioactive ceramics are beginning to be understood, which can result in the molecular design of bioceramics for interfacial bonding with hard and soft tissues. Composites are being developed with high toughness and elastic modulus match with bone. Therapeutic treatment of cancer has been achieved by localized delivery of radioactive isotopes via glass beads. Development of standard test methods for prediction of long-term (20-year) mechanical reliability under load is still needed.

Bioceramics : from concept to clinic

https://zirconia.typepad.com/files/zirconia-as-a-ceramic-biomaterial---piconi---biomaterials-1999.pdf

Zirconia as a ceramic biomaterial

At present, strong requirements in orthopaedics are still to be met, both in bone and joint substitution and in the repair and regeneration of bone defects. In this framework, tremendous advances in the biomaterials field have been made in the last 50 years where materials intended for biomedical purposes have evolved through three different generations, namely first generation (bioinert materials), second generation (bioactive and biodegradable materials) and third generation (materials designed to stimulate specific responses at the molecular level). In this review, the evolution of different metals, ceramics and polymers most commonly used in orthopaedic applications is discussed, as well as the different approaches used to fulfil the challenges faced by this medical field.

https://royalsocietypublishing.org/doi/pdf/10.1098/rsif.2008.0151

Biomaterials in orthopaedics.

What future for zirconia as a biomaterial

Statement of problem Developments in ceramic core materials such as lithium disilicate, aluminum oxide, and zirconium oxide have allowed more widespread application of all-ceramic restorations over the past 10 years. With a plethora of ceramic materials and systems currently available for use, an overview of the scientific literature on the efficacy of this treatment therapy is indicated. Purpose This article reviews the current literature covering all-ceramic materials and systems, with respect to survival, material properties, marginal and internal fit, cementation and bonding, and color and esthetics, and provides clinical recommendations for their use. Material and methods A comprehensive review of the literature was completed seeking evidence for the treatment of teeth with all-ceramic restorations. A search of English language peer-reviewed literature was undertaken using MEDLINE and PubMed with a focus on evidence-based research articles published between 1996 and 2006. A hand search of relevant dental journals was also completed. Randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies, and longitudinal retrospective studies were reviewed. The last search was conducted on June 12, 2007. Data supporting the clinical application of all-ceramic materials and systems was sought. Results The literature demonstrates that multiple all-ceramic materials and systems are currently available for clinical use, and there is not a single universal material or system for all clinical situations. The successful application is dependent upon the clinician to match the materials, manufacturing techniques, and cementation or bonding procedures, with the individual clinical situation. Conclusions Within the scope of this systematic review, there is no evidence to support the universal application of a single ceramic material and system for all clinical situations. Additional longitudinal clinical studies are required to advance the development of ceramic materials and systems.

Current ceramic materials and systems with clinical recommendations: A systematic review

Biomechanical compatibility and design of ceramic implants for orthopedic surgery.

In order to evaluate the contribution of both anterior (ACL) and posterior cruciate ligaments (PCL) in antero-posterior knee laxity, mechanical tests were performed on 31 fresh-cadaver-knees ranging from 20 to 68 years old. The joints flexed at 90 degrees in a mounting apparatus were placed in a testing machine with the tibia fixed in neutral rotation. The load-displacement curves were then analyzed. The results showed that the tensile strength of the ACL decreased greatly with age whereas its stiffness measured during anterior drawer test remained independent of age and sex. Successive resection of the antero-medial (AM) and postero-lateral (PL) bundles of the ACL demonstrated the AM bundle to be the major structure involved in the limitation of tibial displacement in the anterior drawer test. The amount of tibial shift during the anterior drawer test did not reflect the condition of the ACL, while its resection always induced a strong and significant drop in anterior knee stiffness. Dissection of the PCL was always followed by significant posterior tibial displacement during the posterior drawer test of over 10 mm, which did not permit the experimental apparatus to quantify the posterior load displacement relationship.

[Analysis of the mechanical function of the cruciate ligaments in antero-posterior knee laxity. An in vitro study]

Dans le but d'etudier la contribution du pivot ligamentaire central du genou — ligament croise antero-externe (LCAE) et ligament croise postero-interne (LCPI) — dans la stabilite antero-posterieure de cette articulation, le role respectif des deux ligaments croises a ete etudie sur 31 genoux de cadavres frais flechis a 90°, sans rotation tibiale, places sur un montage dans une machine d'essais. Cette etude a permis de demontrer que la resistance a la traction du LCAE decroit fortement avec l'âge, tandis que la rigidite ligamentaire en tiroir anterieur direct (TAD) est independante de l'âge et du sexe. La section successive des faisceaux antero-interne (AI) et postero-externe (PE) du LCAE montre que, dans les conditions experimentales de cette etude, seul le faisceau AI joue un role important dans la laxite en TAD. Si la seule mesure de l'amplitude du TAD a 90° ne permet pas de prejuger de l'etat anatomique du LCAE, par contre, la section complete du LCAE entraine toujours une chute importante et significative de la rigidite ligamentaire en TAD. La section du LCPI entraine toujours un important tiroir posterieur, superieur a 10 cm ce qui n'a pas permis avec la methode utilisee de quantifier la relation force-deplacement posterieur.

A. Meunier

Papers

Biomechanical compatibility and design of ceramic implants for orthopedic surgery.

[Analysis of the mechanical function of the cruciate ligaments in antero-posterior knee laxity. An in vitro study]

Analyse du rôle mécanique des ligaments croisés dans la laxité antéropostérieure du genou

The displacement of the bony insertion of the anterior cruciate ligament during knee flexion