Outcomes of Ceramic Composite in Total Hip Replacement Bearings: A Single-Center Series
Round 1
Reviewer 1 Report
The new text is clearer but the Reference part wasn't modified ( in respect to journal Editors and journal rules). You can find details attached.
Comments for author File: 
Comments.pdf
Author Response
I do not understand what to do in the references. For example the year in references from 24 to 28 is already after the journal name. I do not understand also the others critical issues.
Reviewer 2 Report
- I would suggest some more details if gender and/or age of patients affect the outcome of the trials reported in the manuscript.
- The good practice is to use various types of materials in THA , e.g. doi.org/10.1016/j.cobme.2019.02.003. Please provide some criteria to have a choice on the most appropriate type of material, e.g. metal, ceramic, polymer etc.
- To what extent the statistics provides information on the success rate of implants over patient’s life-span.
- The authors claimed that “AMC–on–AMC coupling provides outstanding outcomes in 328 THA done in high-demand patients, with no material-related side effects, no ceramic frac-329 ture, and no mechanical loosening of implant components”. However, in my opinion it is an idealistic case, because there is no ideal material or implant, which does not reveal situation in the field in general. There are always implants failure caused in particular by the surgeons failures.
Author Response
The aim of this paper is to report the results of total hip replacements performed with a ceramic-on-ceramic articulation made out ceramic composite in a single center, focusing on its usefulness in specific preoperative diagnosis. This is based only on our personal experience, and this is our final version of the study. Thanks
Reviewer 3 Report
This is not a scientifically designed study. The authors did not set any specific hypothesis and research question in the introduction. It was also unspecified what criteria were used to include or exclude the study subjects. Thus, a specific purpose and motivation behind the study are unclear. Despite the fact that long-term follow-up studies of the AMC-on-AMC THA over 10 years have already reported so far, the authors have just introduced their surgical experience of the AMC-on-AMC THA without providing any subsequent follow-up data analyzed statistically. Only the representative postoperative radiographs for 3 particular cases were shown. In addition, the discussion is likely to be based on the author’s personal (subjective) opinions beyond the results obtained from this study. In the above context, the reviewer has to say that the evidence level and clinical significance of this paper are not appreciated and it is unlikely to provide any new insights into the field.
Author Response
As reported in the abstract the aim of this paper is to report the results of total hip replacements performed with a ceramic-on-ceramic articulation made out ceramic composite in a single center, focusing on its usefulness in specific preoperative diagnosis. This is based only on our personal experience, therefore it is obvious that it is not a scientifically designed study.
Round 2
Reviewer 2 Report
The manuscript can be accepted.
Reviewer 3 Report
I have no further queries on this manuscript.
