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1 6 Hip Arthroplasty 4.2 Careful Cleaning and Drying of the Stem Taper As well as damage to the stem taper, contamination of the contact surfaces with foreign material (tissue, cement, bone, blood, etc.) affects the transfer of force to the femoral ball head and has a negative impact on the fracture strength of the femoral ball head (. Fig. 5) [22][23][24]. This means that it is essential to thoroughly clean and dry the stem taper (. Fig. 6,. Fig. ) intraoperatively after removing the protective taper cap (. Fig. 4b) and immediately prior to positioning of the femoral ball head. This is followed by another 4.3 Taper Locking For modular hip arthroplasty it is necessary to join the femoral ball head and the stem taper intraoperatively. A secure connection prevents possible loosening of the femoral ball head as a result of friction forces in the joint. Secure taper locking ensures that the torsional resistance of the femoral ball head. After the initial fixation of a. Fig. 6 Rinsing the stem taper For this reason, a femoral ball head must not be repositioned on such a stem taper. Fig. Rinsing stem. the 6 taper For reason, this a femoral ball head must not be repositioned on such stem a taper. femoral head ball on the stem taper, the taper surface of the stem permanently is deformed. the resistance torsional of the femoral ball head. After the initial fixation a of deforms This irreversibly. increases the contact area and surfaces extrafrictional reinforce When femoral the ball head is positioned on the structured stem taper taper, surface the has surface roughness (. Fig. 9). macrostructure taper stem The excluded. is [11] ions and particles metal of release and corrosion stem-side of possibility the and avoided are components the between movements relative that ensures locking taper Secure joint. the in forces friction of result a as head ball ral femo- the of loosening possible prevents connection secure A intraoperatively. taper stem the and head ball femoral the join to necessary is it arthroplasty hip modular For Locking Taper 4.3 Femoral Head Ball Ceramic 4 the stem taper for possible damage and contamination of with inspection foreign visual immediately prior to positioning of the femoral ball head. This is followed by another and 4b) Fig. (. cap taper protective the removing after intraoperatively ) Fig.. 6, Fig. (. taper Your BIOLOX Multimedia Tools. Anywhere. Anytime. BIOLOX inside App Clinical Guides

2 BIOLOX inside App Your ultimate guide to the use of s in orthopaedics The orthopaedic landscape information journal on-the-go Clinical & material information Features Live surgical videos Handling 3D animations Literature Search function in all issues Text mode reading Image galleries Bookmarks Offline mode Links to additional websites Edited by Springer Medizin BIOLOX inside is an interactive 3D application which compiles the current knowledge about the use of s in orthopedics Numerous videos, animations and resources will provide the physician with information about the use of in hip, knee and shoulder arthroplasty Available languages: English, German, Russian The CeraNews app provides the surgeon interviews, author articles, and case reports about current topics on bearing surfaces in total joint arthroplasty Available languages: English, German, Italian, Chinese, French, Portuguese, Spanish, Japanese, Korean, Russian For Apple and Android tablets and smartphones For Apple and Android tablets and smartphones

3 6 Hip Arthroplasty 4.2 Careful Cleaning and Drying of the Stem Taper As well as damage to the stem taper, contamination of the contact surfaces with foreign material (tissue, cement, bone, blood, etc.) affects the transfer of force to the femoral ball head and has a negative impact on the fracture strength of the femoral ball head (. Fig. 5) [22][23][24]. This means that it is essential to thoroughly clean and dry the stem taper (. Fig. 6,. Fig. ) intraoperatively after removing the protective taper cap (. Fig. 4b) and immediately prior to positioning of the femoral ball head. This is followed by another 4.3 Taper Locking For modular hip arthroplasty it is necessary to join the femoral ball head and the stem taper intraoperatively. A secure connection prevents possible loosening of the femoral ball head as a result of friction forces in the joint. Secure taper locking ensures that the torsional resistance of the femoral ball head. After the initial fixation of a For this reason, a femoral ball head must not be repositioned on such a stem taper. For this reason, a femoral ball head must not be repositioned on such a stem taper. the torsional resistance of the femoral ball head. After the initial fixation of a ral ball head as a result of friction forces in the joint. Secure taper locking ensures that femo- the of loosening possible prevents connection secure A intraoperatively. taper stem the and head ball femoral the join to necessary is it arthroplasty hip modular For Locking Taper 4.3 immediately prior to positioning of the femoral ball head. This is followed by another and 4b) Fig. (. cap taper protective the removing after intraoperatively ) Fig.. 6, Fig. (. taper. Fig. 6 Rinsing the stem taper. Fig. 6 Rinsing the stem taper for the Use of Hartmuth Kiefer Sylvia Usbeck Leslie F. Scheuber Volker Atzrodt The orthopaedic landscape information newsletter as interactive and multimedia emagazine for the Use of Ceramic Implants By Kiefer et al. Hartmuth Kiefer Sylvia Usbeck Leslie F. Scheuber Volker Atzrodt for the Use of Ceramic Implants Ceramic Implants Register for the free online version today: Providing interviews, author articles, case reports about current topics on bearing surfaces in total joint arthroplasty Issued twice a year for thousands of surgeons worldwide New design and digital form New features and interactive content Special focus on advanced BIOLOX s Edited by Springer Medizin This book is intended to impart practical tips and information on the use of hip implants in routine clinical work in a concise and clear manner The strong practical relevance and colorful visual material will enable clinicians to gain a rapid grasp of the most important information As a helpful advisory tool, this Pocket Guide concisely and clearly imparts the current state of knowledge on selected issues of everyday clinical practice and, in doing so, concentrates purely on the essentials Kiefer H et al. 1st ed. 2014, Management of Hip Arthroplasty Clinical 40 p. 24 illus., in color Springer Heidelberg ISBN PDF and EPUB, download immediately Print (Softcover) ISBN

4 in hard-on-hard Bearings for Handling Noises William L. Walter Reza Jenabzdadeh Carina Reinhardt 8 for Handling Noises in Hard-on-Hard Bearings. Fig. 5 Coronal computer tomogram of the insert in case 2 showing rim fracture. 3.2 Case 2 A 64-year-old woman had a -on- hip replacement (36-mm bearing, Biolox forte, CeramTec, Plochingen) 3 years earlier. She had been doing well until she noticed an intermittent crunching and grating noise in her hip with no specific activity. The noise then started occurring with any movement of the hip but was not accompanied by pain. Check-up radiographs and CT scans showed a fracture in the rim of the liner (. Fig. 3,. Fig. 4,. Fig. 5). jcase Solution Revision surgery was undertaken showing some metallosis and fragments in the joint. A complete synovectomy was performed and the acetabular shell, liner, and femoral ball head were changed. After a thorough inspection of the stem taper, it was found to be undamaged so it remained in situ. For revision, a 36-mm Biolox delta -on bearing was used. The patient was doing well after revision and was very satisfied with the outcome. to be undamaged so it remained in situ. For revision, a 36-mm Biolox delta -on- changed. After a thorough inspection of the stem taper, it was found were head ball femoral and liner, shell, acetabular the and performed was synovectomy complete A joint. with the outcome. The patient was doing well after revision and was very satisfied used. was bearing Revision surgery was undertaken showing some metallosis and fragments in the Solution jcase liner (. Fig. 3,. Fig. 4,. Fig. 5). the rim of the in fracture a showed scans CT and radiographs Check-up pain. by The noise then started occurring with any movement of the hip but was not accompanied an intermittent crunching and grating noise in her hip with no specific activity. noticed she until well doing been had She earlier. years 3 Plochingen) CeramTec, forte, Biolox 3.2 Case 2 A 64-year-old woman had a -on- hip replacement (36-mm bearing,. Fig. 5 Coronal computer tomogram of the insert in case 2 showing rim fracture. 4 Clinical Algorithm 4 Clinical Algorithm. Fig. 6 Flowchart: Clinical algorithm according to W. L. Walter for handling noise in total hip replacements.. Fig. 6 Flowchart: Clinical algorithm according to W. L. Walter for handling noise in total hip replacements. 4 Clinical Algorithm 4 Clinical Algorithm Metal Implant Allergy and Immuno-Allergological Compatibility Aspects 4 Is there a release of chromium from Biolox delta discs when they are kept for 5 days under different elution conditions? 4 Do human lymphocytes containing cell cultures show enhanced reactivity in the presence of Biolox delta discs? 4 Will there be a positive (allergic) patch test reaction to chromium-containing material in individuals with metal allergy? Biolox delta contains chromium, which is a potential elicitor of allergic reactions. Thus, the following questions were posed: erties of a composite material (Biolox delta). This study was done because the immuno-allergological prop- investigate to aimed experiments of series subsequent A Ceramics Alumina and Material Composite Ceramic 4.1 Ceramic Composite Material of Compatibility Immuno-allergological 4 hemagglutinin, SI stimulation index, + additional presence of Al 2O3 and 15 nonallergic blood donors. Statistics: t test. Medium culture medium, NiSO4 (Biolox forte) disc nickel sulfate, PHA phyto- nickel-allergic 15 from cells mononuclear blood peripheral of (pg/ml) production (IFN)-γ Interferon 5 Fig.. IFNg production [pg/ml] M 10-5M 10-5M+ 10-6M 10-4M+ 10-6M+ NiSO4 NiSO4 NiSO4 NiSO4 NiSO4 NiSO4 PHA+ PHA Medium+ Medium 0, Ni ECT pos Ni ECT neg 0,1 Medium Medium+ PHA PHA+ NiSO4 NiSO4 NiSO4 NiSO4 NiSO4 NiSO4 10-4M 10-4M+ 10-5M 10-5M+ 10-6M 10-6M+. Fig. 5 Interferon (IFN)-γ production (pg/ml) of peripheral blood mononuclear cells from 15 nickel-allergic and 15 nonallergic blood donors. Statistics: t test. Medium culture medium, NiSO 4 nickel sulfate, PHA phytohemagglutinin, SI stimulation index, + additional presence of Al 2O 3 (Biolox forte) disc 4 Immuno-allergological Compatibility of Ceramic Composite Material 4.1 Ceramic Composite Material and Alumina Ceramics A subsequent series of experiments aimed to investigate the immuno-allergological properties of a composite material (Biolox delta). This study was done because Biolox delta contains chromium, which is a potential elicitor of allergic reactions. Thus, the following questions were posed: 4 Will there be a positive (allergic) patch test reaction to chromium-containing material in individuals with metal allergy? 4 Do human lymphocytes containing cell cultures show enhanced reactivity in the presence of Biolox delta discs? 4 Is there a release of chromium from Biolox delta discs when they are kept for 5 days under different elution conditions? Ni ECT neg pos ECT Ni Implant Allergy and Immuno-Allergological Compatibility Aspects 10 Metal 4 Immuno-allergological Compatibility of Ceramic Composite Material. Tab. 2 Positive patch test reactions in 200 consecutive individuals Contact allergen Reacting patients (%) Nickel(II)-sulfate Cobalt(II)-chloride 15.5 Thiomersal 14 Fragrance mix 12 6 Balsam of Peru 12 6 Potassium dichromate 10 5 Dibromodicyanobutane, phenoxyethanol p-phenylenediamine 8 4 Colophonium 6 3 Neomycin sulfate 6 3 Thiuram mix 6 3 Mercury(II)-amid-chloride Benzocaine 4 2 Formaldehyde 4 2 Paraben mix 4 2 Lanolin alcohol 4 2 Composite mix Amerchol L Bufexamac 2 1 Cocamidopropyl betaine 2 1 Mercapto mix 2 1 Propolis 2 1 Biolox delta discs 0 0 Patch testing was done in a consecutive series of 200 patients visiting the clinic. The patch test was applied on the patient s back using a European standard series of 30 allergens (Hermal, Reinbek, Germany) supplemented by a sterilized disc (Biolox delta, CeramTec, Plochingen, Germany). The reactions were evaluated according to a standard procedure on days 3 and 4 [3]. Nickel was the most frequent allergen with 14.5% positive reactions. None of the patients reacted to the Biolox delta discs. The results are summarized in. Tab. 2. rized in. Tab. 2. reactions. None of the patients reacted to the Biolox delta discs. The results are summa- frequent allergen with 14.5% positive most the was Nickel [3]. 4 and 3 days on procedure standard a to according evaluated were reactions The Germany). Plochingen, CeramTec, (Hermal, Reinbek, Germany) supplemented by a sterilized disc (Biolox delta, test was applied on the patient s back using a European standard series of 30 allergens patch The clinic. the visiting patients 200 of series consecutive a in done was testing Patch Propolis 2 1 Biolox delta discs 0 0 Cocamidopropyl betaine 2 1 Mercapto mix 2 1 Amerchol L Bufexamac 2 1 Lanolin alcohol 4 2 Composite mix Formaldehyde 4 2 Paraben mix 4 2 Mercury(II)-amid-chloride Benzocaine 4 2 Neomycin sulfate 6 3 Thiuram mix 6 3 p-phenylenediamine 8 4 Colophonium 6 3 Potassium dichromate 10 5 Dibromodicyanobutane, phenoxyethanol Balsam of Peru 12 6 Fragrance mix 12 6 Thiomersal 14 Cobalt(II)-chloride 15.5 Nickel(II)-sulfate (%) patients Reacting allergen Contact individuals consecutive 200 in reactions test patch Positive 2 Tab.. 4 Immuno-allergological Compatibility of Ceramic Composite Material Allergological Compatibility Aspects for Handling Noises in hard-on-hard Bearings By Walter et al. Metal Implant Allergy and Immuno- Allergological Compatibility Aspects Thomas et al. Clinical Management of Joint Arthroplasty William L. Walter Reza Jenabzdadeh Carina Reinhardt for Handling Noises in hard-on-hard Bearings IFNg production [pg/ml] Peter Thomas Susanna Stea Metal Implant Allergy and Immuno- Allergological Compatibility Aspects Walter W et al. 22 pages, 15,5 x 23,5 cm First Edition 2015 Springer-Verlag Berlin Heidelberg 2015 Print (Softcover): ISBN ISBN This book provides recommendations and a clinical algorithm for the assessment of noise in total hip arthroplasties with hard-on-hard bearings It covers all aspects from diagnostics to therapy and adequate management, as well as monitoring, possible prevention, and patient information Current thinking and scientific knowledge regarding noises including squeaking in hard-on-hard bearings Case reports This pocket guide presents background information and ways to proceed in patients when an implant allergy is suspected as diagnostic criteria of hypersensitivity to metal implants are inconclusive For the first time, a clinical algorithm has been developed for procedures in clinical practice for when an implant allergy is suspected. The algorithm is presented as a laminated loose insert The flow chart contains additional information on the histopathological particle algorithm, according to Krenn Metal Implant Allergy and Immuno- Thomas P et al. 1st ed. 2015, Peter Thomas Susanna Stea Management of Joint Arthroplasty Clinical 36 p. 1 illus., in color Springer Heidelberg ISBN PDF and EPUB, download immediately Print (Softcover) ISBN

5 BIOLOX inside App Your ultimate guide to the use of s in orthopaedics (app for ios and Android smartphones and tablets) The orthopaedic landscape information journal on-the-go (app for ios and Android smartphones and tablets) The orthopaedic landscape information newsletter as interactive and multimedia emagazine Clinical Guides Practical clinical guides edited by Springer from surgeons for surgeons with useful tips and information on the use of implants for your routine clinical work Apple, the Apple logo, iphone and ipad are trademarks of Apple Inc. registered in the U.S. and other countries. Android is a trademark of Google Inc. BIOLOX is a registered trademark CeramTec GmbH CeramTec GmbH Medical Products Division CeramTec-Platz 1 9 D-320 Plochingen Tel Fax medical_products@ceramtec.de Review: June 2015