Hip Pelvis.  2013 Dec;25(4):292-296. 10.5371/hp.2013.25.4.292.

Failure of a Metal Femoral Head after Revision Total Hip Arthroplasty for a Ceramic Liner Fracture

• Park KS
• Kim HS
• Lee SH
• Yoon TR

• KMID: 1808138
• DOI: http://doi.org/10.5371/hp.2013.25.4.292

Abstract

Popularity of ceramic materials has increased among joint reconstruction surgeons for treatment of young patients who wish to maintain their active lifestyle. However, ceramic fracture is one of the most serious complications, and there are many concerns regarding the acceleration of third body wear and refracture of ceramic articulation after revision total hip arthroplasty for a ceramic fracture. To date, a few authors have reported on complications due to residual ceramic particles after revision surgery. We report on a case of metallosis due to metal head wear caused by residue of fractured ceramic particles lodged in the polyethylene liner after revision total hip arthroplasty for a ceramic liner fracture.

Keyword

Total hip arthroplasty; Revision; Ceramic fracture; Metallosis

MeSH Terms

Acceleration
Arthroplasty, Replacement, Hip*
Ceramics*
Head*
Humans
Joints
Life Style
Polyethylene
Ceramics
Polyethylene

Figure

• 

  Fig. 1 (A) The anteroposterior radiograph of both hip shows ceramic liner fracture in right hip. (B) The anteroposterior radiograph of both hip shows flattened metal femoral head and Bubble like lesion (sign of severe metallosis) around the right hip. (C) Right hip lateral view shows the Bubble like lesion placed along the anterior soft tissue & posterior to the acetabulum. (D) CT-pelvis, axial view shows metallosis lesion in the area of greater sciatic notch area. (E) CT-pelvis, axial view shows metallosis lesion in the area on rectus femoris muscle belly. (F) CT-pelvis, axial view shows ceramic debris in right hip anteromedial area.

• 

  Fig. 2 (A) Intraoperative photograph during right revision THA shows a black-stained tissue indicating metallosis in the rectus femoris muscle. (B) Severe metallosis was seen underneath the rectus femoris muscle after dissection. (C) A photo shows the sciatic nerve compression by the metallosis mass lesion. (D) A photo shows flattened metal femoral head and there was a hole on top of femoral head filled with polyethylene debris. (E) A photo shows eccentric wear of polyethylene and perforated metal femoral head. (F) Four ceramic particles found during the revision surgery. (G) A photo shows debrided mass.

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  Fig. 3 (A) Right hip AP radiographs after 2 year of re-revision THA show the remained debris due to metallosis within the substance of rectus femoris muscle. (B) Right hip lateral radiographs after 2 year of re-revision THA show the remained debris due to metallosis within the substance of rectus femoris muscle.

• 

  Fig. 4 Follow-up results of the Cr-Co level. (POD: postoperative day, M: months, Y: year).

Reference

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