J Korean Hip Soc.  2012 Mar;24(1):59-64. 10.5371/jkhs.2012.24.1.59.

Repeated Ceramic Head Fracture after Ceramic-on-ceramic Total Hip Arthroplasty

• Park MS
• Yoon SJ
• Yoo MJ

• KMID: 2014899
• DOI: http://doi.org/10.5371/jkhs.2012.24.1.59

Abstract

Alumina ceramic-on-ceramic total hip arthroplasty is a widely-adopted option, especially for younger patients, due low wear, scratch resistance, the wettable characteristics of alumina ceramics, and because of the relatively low biological reactivites of ceramic wear particles. However, fracture remains a significant problem because ceramics are inherently brittle, and few reports have been issued on short head fractures. In the described case, a ceramic head fracture occurred only 8 months after replacing the original head and with a new 28 mm head and liner. Both of these incidents may have been caused by head-to-liner impingement due to excessive anteversion of the metal shell. During the second revision surgery, this situation was managed successfully using a conventional elevated-polyethylene liner and a CoCr metal head, while retaining all metal implants.

Keyword

Total hip arthroplasty; Ceramic-ceramic total hip arthroplasty; Ceramic head fracture

MeSH Terms

Aluminum Oxide
Arthroplasty
Ceramics
Head
Hip
Humans
Aluminum Oxide
Ceramics

Figure

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  Fig. 1 Ceramic head fracture in the left hip.

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  Fig. 2 Computed tomograph showing ceramic head fracture fragments were retained by the metal shell.

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  Fig. 3 A new ceramic head and liner were inserted.

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  Fig. 4 (A) Second fracture of the ceramic head with dislocation and (B) cross sectional computed tomograph showing excessive anteversion of the metal shell and femoral stem.

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  Fig. 5 (A) A rim fracture and metal staining of the ceramic liner and multiple fragments of the ceramic head and (B) a deep groove (white arrow) was observed on the lateral base of the femoral stem.

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  Fig. 6 New polyethylene liner and metal head were fitted to retained metal shell and the existing femoral component and small pieces of particles can be seen at posterosuperior capsule.

Reference

1. Barrack RL, Burak C, Skinner HB. Concerns about ceramics in THA. Clin Orthop Relat Res. 2004. 429:73–79.

2. Bierbaum BE, Nairus J, Kuesis D, Morrison JC, Ward D. Ceramic-on-ceramic bearings in total hip arthroplasty. Clin Orthop Relat Res. 2002. 405:158–163.

3. Sedel L. Evolution of alumina-on-alumina implants: a review. Clin Orthop Relat Res. 2000. 379:48–54.

4. Hannouche D, Nich C, Bizot P, Meunier A, Nizard R, Sedel L. Fractures of ceramic bearings: history and present status. Clin Orthop Relat Res. 2003. 417:19–26.

5. Arenas A, Tejero A, Garbayo A, Arias C, Barbadillo J, Lecumberri J. Ceramic femoral head fractures in total hip replacement. Int Orthop. 1999. 23:351–352.

6. Murphy SB, Ecker TM, Tannast M. Two- to 9-year clinical results of alumina ceramic-on-ceramic THA. Clin Orthop Relat Res. 2006. 453:97–102.

7. Pulliam IT, Trousdale RT. Fracture of a ceramic femoral head after a revision operation. A case report. J Bone Joint Surg Am. 1997. 79:118–121.

8. Torán MM, Cuenca J, Martinez AA, Herrera A, Thomas JV. Fracture of a ceramic femoral head after ceramic-on-ceramic total hip arthroplasty. J Arthroplasty. 2006. 21:1072–1073.

9. Diwanji SR, Seon JK, Song EK, Yoon TR. Fracture of the ABC ceramic liner: a report of three cases. Clin Orthop Relat Res. 2007. 464:242–246.

10. Ha YC, Kim SY, Kim HJ, Yoo JJ, Koo KH. Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. Clin Orthop Relat Res. 2007. 458:106–110.

11. Hasegawa M, Sudo A, Uchida A. Alumina ceramic-on-ceramic total hip replacement with a layered acetabular component. J Bone Joint Surg Br. 2006. 88:877–882.

12. Skinner HB. Ceramic bearing surfaces. Clin Orthop Relat Res. 1999. 369:83–91.

13. D'Antonio J, Capello W, Manley M, Bierbaum B. New experience with alumina-on-alumina ceramic bearings for total hip arthroplasty. J Arthroplasty. 2002. 17:390–397.

14. Garino JP. Modern ceramic-on-ceramic total hip systems in the United States: early results. Clin Orthop Relat Res. 2000. 379:41–47.

15. Park YS, Hwang SK, Choy WS, Kim YS, Moon YW, Lim SJ. Ceramic failure after total hip arthroplasty with an alumina-on-alumina bearing. J Bone Joint Surg Am. 2006. 88:780–787.

16. Hasegawa M, Sudo A, Hirata H, Uchida A. Ceramic acetabular liner fracture in total hip arthroplasty with a ceramic sandwich cup. J Arthroplasty. 2003. 18:658–661.

17. Callaway GH, Flynn W, Ranawat CS, Sculco TP. Fracture of the femoral head after ceramic-on-polyethylene total hip arthroplasty. J Arthroplasty. 1995. 10:855–859.

18. Maccauro G, Piconi C, Burger W, et al. Fracture of a Y-TZP ceramic femoral head. Analysis of a fault. J Bone Joint Surg Br. 2004. 86:1192–1196.

19. Masonis JL, Bourne RB, Ries MD, McCalden RW, Salehi A, Kelman DC. Zirconia femoral head fractures: a clinical and retrieval analysis. J Arthroplasty. 2004. 19:898–905.

20. Willmann G. Ceramic femoral head retrieval data. Clin Orthop Relat Res. 2000. 379:22–28.

21. Koo KH, Ha YC, Jung WH, Kim SR, Yoo JJ, Kim HJ. Isolated fracture of the ceramic head after third-generation alumina-on-alumina total hip arthroplasty. J Bone Joint Surg Am. 2008. 90:329–336.

22. Kim YH, Ritchie A, Hardaker C. Surface roughness of ceramic femoral heads after in vivo transfer of metal: correlation to polyethylene wear. J Bone Joint Surg Am. 2005. 87:577–582.

23. Luchetti WT, Copley LA, Vresilovic EJ, Black J, Steinberg ME. Drain entrapment and titanium to ceramic head deposition: two unique complications following closed reduction of a dislocated total hip arthroplasty. J Arthroplasty. 1998. 13:713–717.

24. Yoo JJ, Kim HJ, Kim YM. Damage of an alumina-on-alumina bearing surface from a difficult reduction of a total hip arthroplasty. A report of three cases. J Bone Joint Surg Am. 2004. 86-A:376–378.