Ceramic components have been successfully used for many years in hip and knee replacement. In shoulder arthroplasty, ceramic couplings and even ceramic prostheses have been recognised since 1979¹, and later by Huckstep and Sherry² in 1996 and Tschirren and Thabe in 1991. 

The first ceramic replacement was a complete humerus which had been affected by a destructive bone tumour¹.  

In 1998 Jerosch combined a proximal HA coated stem with a ceramic head in a fracture prosthesis. Until now, no comparable clinical data were available on shoulder replacement in terms of reliability, wear and biocompatibility. We based our research on data about hip replacement, despite the evident differences in joint anatomy, loads and movement.
A low complication rate with the use of ceramic-on-ceramic coupling, and consequently the low revision rate was confirmed³.
A good result in young and active patients was reported in a prospective ceramic-ceramic study with 99.1% survival of the ceramic component at 5 years⁴. Assessing ceramic wear in the hip simulator, Kaddick confirmed <1mg/mio cycles wear in ceramic-ceramic coupling in comparison to metal-polyethylene (UHMW-PE) combination with <100mg/mio cycles⁵. There are many in vitro and in vivo studies on the biocompatibility of ceramics. Fisher confirmed the high functional biological safety of ceramic⁶. Age is a concern in patients with disabling shoulder disease. UHMW-PE wear and osteolysis resulted in a high revision rate following reverse total shoulder arthroplasty (RTSA). 

This lead to a restriction of indications. Better mid-term results were achieved with the new polyethylene glenosphere, significantly reducing UHMW-PE wear thanks to the inversion of the materials⁷. 

The indication of young and active patients as well as allergic patients were the basis for the design of a ceramic liner for the 44 mm Reverse Total Shoulder Arthroplasty.

Preliminary tests, comparing the ceramic liner with CoCrMo liners showed a decrease of 35% in glenosphere wear (Fig.1). These very good in vitro results were the foundations for initiating a clinical study. 

Of primary importance is the fact that there is now a comparable implant available for allergic patients. There is now an implant for young and active patients which provides low component wear and so high biocompatibility with low revision rates for wear and implant failure (Fig. 2). 

Mid and long term results after this prospective study must confirm the very promising in vitro results of the ceramic coupling in shoulder arthroplasty.

1. Sim FH, Chao EY, Pritchard DJ, Salzer M. Replacement of the proximal humerus with a ceramic prosthesis: a preliminary report. Clin Orthop Relat Res. 1980 Jan-Feb;(146):161-74.
2. Huckstep RL, Sherry E. Replacement of the proximal humerus in primary bone tumours. Aust N Z J Surg. 1996 Feb;66(2):97-100.
3.  Chatelet JC, Setiey L. Résultats à 10 ans de recul dune étude comparative prospective randomisée sur des PTH avec couple céramique céramique vs. métal métal (Sandwich). Proceedings of the 85th Annual Meeting of the Société française de chirurgie orthopédique et traumatologie (SOFCOT); 2010 Nov 8-12; Paris, France.
4. Le Meur M, Lecoz L, Tayeb A, Louis ML, Curvale G, Rochwerger A. Analyse de survie dun couple de frottement céramique céramique à plus de 5 ans, à propos dune cohorte de 108 patients. 85th Annual Meeting of the Société française de chirurgie orthopédique et traumatologie (SOFCOT); 2010 Nov 8-12; Paris, France.
5. Kaddick C, Wimmer MA. Hip simulator wear testing according to the newly introduced standard ISO 14242.Proc Inst Mech Eng H. 2001;215(5):429-42.
6. Fisher J, Jin Z, Tipper J, Stone M, Ingham E. Tribology of alternative bearings. Clin Orthop Relat Res. 2006 Dec; 453:25-34.
7. Castagna A, Bischof A, Budassi P, Agneskirchner J, Domenghini C, Borroni  M,, Frattini M, Zon S, Bloch HR. Comparison of Clinical outcomes of Reverse Total Shoulder Arthroplasty performed with 36mm standard, 36mmm eccentric CoCrMo and 44 mm cross-linked UHMWPE glenospheres: a multicenter study. Proceedings of the 12th European Federation of National Association of Orthopaedics and Traumatology (EFORT); 2011 Jun 1-4; Copenhagen, Denmark.