title: Ceramic femoral component fracture in total knee arthroplasty: an analysis using fractography, fourier-transform infrared microscopy, contact radiography and histology.
abstract: Ceramic components in total knee arthroplasty (TKA) are evolving. We analyze the first case of BIOLOX delta ceramic femoral component fracture. A longitudinal midline fracture in the patellar groove was present, with an intact cement mantle and no bony defects. Fractographic analysis with laser scanning microscopy and white light interferometry showed no evidence of arrest lines, hackles, wake hackles, material flaws, fatigue or crack propagation. Analysis of periprosthetic tissues with Fourier-transform infrared (FT-IR) microscopy, contact radiography, histology, and subsequent digestion and high-speed centrifugation did not show ceramic debris. A macrophage-dominated response was present around polyethylene debris. We conclude that ceramic femoral component failure in this case was related to a traumatic event. Further research is needed to determine the suitability of ceramic components in TKA.
authors.affiliation: Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Krueger
authors.affiliation: Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany; University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National, University Health System, Singapore, Singapore.
authors.forename: Gurpal
authors.initials: G
authors.lastname: Singh
authors.affiliation: Department of Orthopaedics, University of Hamburg, Hamburg, Germany.
authors.forename: Frank Timo
authors.initials: FT
authors.lastname: Beil
authors.affiliation: Department of Mechanical Engineering, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Feuerstein
authors.affiliation: Department of Orthopaedics, University of Hamburg, Hamburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ruether
authors.affiliation: Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany.
authors.forename: Christoph H
authors.initials: CH
authors.lastname: Lohmann
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001672:Biocompatible Materials; D002516:Ceramics; D019544:Equipment Failure Analysis / Q000379:methods*; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011475:Prosthesis Failure
chemical_list: D001672:Biocompatible Materials
keywords: ceramic; femoral component; fracture; infrared microscopy; total knee arthroplasty