Ceramic humeral heads in shoulder arthroplasty: a systematic review

Hypothesis

Total shoulder arthroplasty has been used for over 50 years to treat glenohumeral arthritis. In recent years, one area of innovation has been the use of ceramic-bearing surfaces. The advantages of ceramic bearing surfaces include utility in stemless implants and hemiarthroplasty, where their use in hip arthroplasty has been shown to decrease wear rates compared to metal implants and potentially reduced revision rates. With interest in utilizing ceramics for other arthroplasty indications continuing to grow, the purpose of this systematic review is to consolidate recent clinical findings involving ceramic-bearing surfaces to determine their suitability for anatomic shoulder replacement.

Methods

Medline, Embase, and Cochrane Library were searched up to April 2024 according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Metrics analyzed include patient-reported outcome measures, postoperative complications, and radiographic findings. Secondary outcomes included forward flexion, external rotation, and abduction.

Results

Eight studies comparing 716 patients were included with an average follow-up of 57.3 months (range 24-70.7). The mean age for the study population was 67.7 year old. All 8 studies included cohorts that had undergone shoulder arthroplasty with an implant with a ceramic humeral head component. All studies showed significant improvement in range of motion and patient outcome scores both postoperatively and up to 2 years after the patient's initial operation. Patient satisfaction was similarly positive, with 97% of patients reporting satisfactory results. Radiographically, 6 studies reported Lazarus grades with 71.9% (213/296) were grade 0, 23.3% (69/296) were grade 1, 3.7% (11/296) were grade 2, and 0.67% (2/296) demonstrated a grade 3 Lazarus score. One study presented a patient with a grade 5 Lazarus, making up only 0.34% (1/296) of the observed population.

Conclusion

Anatomic shoulder replacements using ceramic-bearing surfaces show safety and efficacy at numerous follow-up intervals, with complication rates approaching those of historical controls with metal implants. Future randomized controlled trials should be performed to investigate potential advantages compared to titanium and cobalt-chromium alloy humeral heads.