This is the first systematic review to pool clinical outcomes of ceramic humeral heads in anatomic total shoulder arthroplasty. It asks whether ceramic bearing surfaces are safe and effective enough to justify their use over titanium and cobalt-chromium heads. Eight studies and 716 patients were analyzed for patient-reported outcomes, complications, and radiographic loosening.
The mechanistic case for ceramic heads is wear reduction: a ceramic head against polyethylene generates fewer wear particles than metal, which means less osteolysis and fewer glenoid radiolucent lines over time.
That theory holds up radiographically here. The one comparative study showed significantly fewer glenoid radiolucent lines with ceramic than cobalt-chromium (P < .001), and roughly 95% of patients were Lazarus grade 0 or 1.
But do not overread this. Rotator cuff failure, not bearing wear, drove a third of all revisions, matching conventional aTSA. Ceramic solves a wear problem, not the cuff problem.
Weight this evidence carefully. It is Level IV with only one comparative study, short follow-up around 57 months, and no standardized glenoid or cementation technique. Ceramic heads look safe and effective, but whether they beat metal long-term remains unproven and awaits randomized trials.
This is the first systematic review to pool clinical outcomes of ceramic humeral heads in anatomic total shoulder arthroplasty. It asks whether ceramic bearing surfaces are safe and effective enough to justify their use over titanium and cobalt-chromium heads. Eight studies and 716 patients were analyzed for patient-reported outcomes, complications, and radiographic loosening.
The mechanistic case for ceramic heads is wear reduction: a ceramic head against polyethylene generates fewer wear particles than metal, which means less osteolysis and fewer glenoid radiolucent lines over time.
That theory holds up radiographically here. The one comparative study showed significantly fewer glenoid radiolucent lines with ceramic than cobalt-chromium (P < .001), and roughly 95% of patients were Lazarus grade 0 or 1.
But do not overread this. Rotator cuff failure, not bearing wear, drove a third of all revisions, matching conventional aTSA. Ceramic solves a wear problem, not the cuff problem.
Weight this evidence carefully. It is Level IV with only one comparative study, short follow-up around 57 months, and no standardized glenoid or cementation technique. Ceramic heads look safe and effective, but whether they beat metal long-term remains unproven and awaits randomized trials.