High-Performance Ceramics in Musculoskeletal Surgery: Current Use and Future Perspectives

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The review paper is focused on the high-performance bioceramics used in orthopaedics. Auhtors mention the musculoskeletal surgeries and describe their properties with a particular emphasis on the osseointegration process. The paper represents a good picture of the current state of the art on this topic and includes some discussions about novel possibilities in the field of ceramic implants. The review is well written, and the readability is acceptable for the journal´s readers. I propose the following recommendations:

1. to include legal considerations and regulatory obligations related to the use of high-performance bioceramics.

2. to "discuss" in Section 7. I strongly believe that the discussion section sounds like a summary section. So please, I encourage you to modify to discuss the possibilities that the authors already anticipate in the text.

Comments on the Quality of English Language

Minor corrections suggested but language is acdeptable.

Author Response

Reviewer 1:

Comments and Suggestions for Authors

The review paper is focused on the high-performance bioceramics used in orthopaedics. Auhtors mention the musculoskeletal surgeries and describe their properties with a particular emphasis on the osseointegration process. The paper represents a good picture of the current state of the art on this topic and includes some discussions about novel possibilities in the field of ceramic implants. The review is well written, and the readability is acceptable for the journal´s readers. I propose the following recommendations:

1. to include legal considerations and regulatory obligations related to the use of high-performance bioceramics.

Dear Reviewer,

Thank you for your review. We addressed this topic in an additional chapter (7. ). We hope that it fits.

 

2. to "discuss" in Section 7. I strongly believe that the discussion section sounds like a summary section. So please, I encourage you to modify to discuss the possibilities that the authors already anticipate in the text.

Thank you for your comment. We revised the part and add some aspects.

 

 

Comments on the Quality of English Language

Minor corrections suggested but language is acceptable.

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is a well-written review that focuses on ceramics. However, as a biocompatible material, titanium implants cannot be ignored either. Is it necessary to mention the comparison with titanium implants?

 

Although it has been stated that ceramic has excellent mechanical properties, their properties differ from those of bone tissue. How do you consider mechanical affinity?

 

Although the material properties of ZTA and ATZ are listed in 3.1.4, the items listed are different. I think it is necessary to state the reason.

 

Author Response

Reviewer 2:

Comments and Suggestions for Authors

This is a well-written review that focuses on ceramics. However, as a biocompatible material, titanium implants cannot be ignored either. Is it necessary to mention the comparison with titanium implants?

Although it has been stated that ceramic has excellent mechanical properties, their properties differ from those of bone tissue. How do you consider mechanical affinity?

Thank you for your comment. We addressed this point in the discussion.

 

 

Although the material properties of ZTA and ATZ are listed in 3.1.4, the items listed are different. I think it is necessary to state the reason.

Thank you for your comment. We revised the part.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This paper is interesting, well written and fits with the Journal scope.

However, there are a few aspects deserving improvement or revision

 

1. The paper focuses on bioinert ceramics in medicine, especially for joint prostheses; this should be specified in the title, abstract and also at the end of section 2 so that Reader can immediately catch the main topic.

 

2. Table 2 needs improvements; more examples of implants could be added, and also some commercial devices.

 

3. Non-oxide ceramics deserve to be described more because they are valuable alternative to classical oxide ceramics; you could consider and cite this recent paper, for example:

Non-oxide ceramics for bone implant application: state-of-the-art overview with an emphasis on the acetabular cup of hip joint prosthesis. Ceramics 2023;6:994-1016

 

4. Line 611-618: HAp is presented as bioresorbable, but this is incorrect. HAp is soluble in nanometric form, otherwise it can be considered almost permanent (its dissolution kinetics is extremely low). This is the reason why other calcium phosphates, with Ca/P ratio lower than that of HAp, are used in bone repair due to the faster dissolution (e.g. alpha and beta-TCP).

Author Response

Reviewer 3:

Comments and Suggestions for Authors

This paper is interesting, well written and fits with the Journal scope.

However, there are a few aspects deserving improvement or revision

1. The paper focuses on bioinert ceramics in medicine, especially for joint prostheses; this should be specified in the title, abstract and also at the end of section 2 so that Reader can immediately catch the main topic.

Dear Reviewer,

Thank you for your comments.

We mentioned in our paper that the focus is on:

“In the following, the focus will be on bioactive and bioinert ceramics.”

 

2. Table 2 needs improvements; more examples of implants could be added, and also some commercial devices.

We inserted some additional information.

 

3. Non-oxide ceramics deserve to be described more because they are valuable alternative to classical oxide ceramics; you could consider and cite this recent paper, for example: Non-oxide ceramics for bone implant application: state-of-the-art overview with an emphasis on the acetabular cup of hip joint prosthesis. Ceramics 2023;6:994-1016

Thank you for the tip. We inserted a small paragraph in the discussion.

 

4. Line 611-618: HAp is presented as bioresorbable, but this is incorrect. HAp is soluble in nanometric form, otherwise it can be considered almost permanent (its dissolution kinetics is extremely low). This is the reason why other calcium phosphates, with Ca/P ratio lower than that of HAp, are used in bone repair due to the faster dissolution (e.g. alpha and beta-TCP).

Thank you for your thoughts. You are right. We corrected it. We withdraw “resorbable” from the headline.

Author Response File: Author Response.pdf