Volume 2, Issue 3, Pages (September 2016)

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Volume 2, Issue 3, Pages 89-92 (September 2016) Histologic evaluation of the bone-ceramic interface of an alumina ceramic cup arthroplasty retrieved after 25 years in vivo Fuminori Higuchi, MD, Shigeo Fukunishi, MD, Shoji Nishio, MD, Tomokazu Fukui, MD, Yuki Fujihara, MD, Shohei Okahisa, MD, Yu Takeda, MD, Shinichi Yoshiya, MD Arthroplasty Today Volume 2, Issue 3, Pages 89-92 (September 2016) DOI: 10.1016/j.artd.2015.08.001 Copyright © 2016 The Authors Terms and Conditions

Figure 1 Anteroposterior radiograph of the left hip before revision surgery. Twenty-five years after cup arthroplasty, an alumina ceramic cup (Kyocera Corp.) survived with appropriate cup inclination angle and no varus slipping or shortening of the neck. Severe periarticular heterotypic ossification associated with traumatic brain injury and comminuted pelvic fractures were noted. Arthroplasty Today 2016 2, 89-92DOI: (10.1016/j.artd.2015.08.001) Copyright © 2016 The Authors Terms and Conditions

Figure 2 Computed tomography image of the hip joint. The axial image demonstrates that the femoral head and ceramic cup are void of significant gaps. Arthroplasty Today 2016 2, 89-92DOI: (10.1016/j.artd.2015.08.001) Copyright © 2016 The Authors Terms and Conditions

Figure 3 Postoperative anteroposterior radiograph of the left hip. Hybrid revision THA has been performed. Arthroplasty Today 2016 2, 89-92DOI: (10.1016/j.artd.2015.08.001) Copyright © 2016 The Authors Terms and Conditions

Figure 4 Gross sagittal section of the femoral head and ceramic implant. The femoral head and ceramic implant show good fixation between the bone and ceramic. (a) Gross finding, (b) section of low magnification with hematoxylin and eosin staining, and (c) the scanning electron microscope (S-3400; Hitachi) analysis with low magnification. Arthroplasty Today 2016 2, 89-92DOI: (10.1016/j.artd.2015.08.001) Copyright © 2016 The Authors Terms and Conditions

Figure 5 Sections of higher magnification with hematoxylin and eosin staining. The bone-ceramic interface showed a thin fibrous membrane in the red area (*). A section was showing tight contact between the fibrous membrane and adjacent bone (**) because of the presence of an uneven surface. Arthroplasty Today 2016 2, 89-92DOI: (10.1016/j.artd.2015.08.001) Copyright © 2016 The Authors Terms and Conditions

Figure 6 SEM with energy-dispersive X-ray (EDAX) analysis. (a) SEM analysis: there were fibrous membranes with a thickness of 50-300 μm and no direct contact between the bone and ceramic (A*). Cancellous bone, which consisted of the trabecula pattern associated with osteocytes as the biological apatite layer (C*), was seen along with the medial side of the fibrous membranes. There was no clear border between the fibrous membrane and bone, and the fibrous membranes were gradually transferred to the bone. There was a white area in the border, which did not consist of the trabecula pattern (B*). (D) ceramic cup (E) and the space of the artificial slit formation. (b) Energy-dispersive X-ray analysis: the area (B*) indicated that Ca and P were detected to be the same peak pattern as that of the cancellous bone (C*). Arthroplasty Today 2016 2, 89-92DOI: (10.1016/j.artd.2015.08.001) Copyright © 2016 The Authors Terms and Conditions