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HSS Journal ®

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01-02-2015 | Original Article

Ceramic Liner Fracture and Impingement in Total Hip Arthroplasty

Authors: Amy Steinhoff, MD, Victor Hakim, MD, Richard H. Walker, MD, Clifford W. Colwell Jr., MD, Steven N. Copp, MD

Published in: HSS Journal ® | Issue 1/2015

Abstract

Background

Ceramic-on-ceramic bearing surfaces were developed to provide an alternate to metal-on-polyethylene to decrease wear-induced osteolysis in total hip arthroplasty patients. In an effort to decrease the risk of ceramic acetabular component fracture or damage during implantation, a raised metal rim was added.

Questions/Purposes

How many fractures or impingements have occurred in our population of patients with ceramic liners with raised rims?

Methods

With IRB-approved consent, a case series was reviewed from a single center registry and 4 of 169 patients were identified who had revision hip surgery with the ceramic liner with a raised metal rim: one for ceramic liner fracture and three for metallosis, pain, and squeaking. Implant alignment and operative findings were reviewed.

Results

One ceramic liner fracture and three cases of metallosis from impingement of the femoral neck on the posterior elevated metal rim of the acetabular liner were observed at revision. The femoral neck in each patient had a divot that corresponded to a divot in the posterosuperior liner rim. Three of the four patients had audible squeaking or clicking prior to revision. A total of 3% of patients in this series had clinically significant impingement with this implant type.

Conclusion

Acoustic phenomenon in a ceramic on ceramic bearing surface should be investigated with a cross-table lateral radiograph to evaluate component position. If symptomatic impingement is demonstrated, revision should be considered to avoid failure from metallosis or fracture.

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Allain J, Goutallier D, Voisin MC, Lemouel S. Failure of a stainless-steel femoral head of a revision total hip arthroplasty performed after a fracture of a ceramic femoral head. A case report. J Bone Joint Surg Am. 1998; 80(9): 1355-1360.PubMed

Allain J, Roudot-Thoraval F, Delecrin J, Anract P, Migaud H, Goutallier D. Revision total hip arthroplasty performed after fracture of a ceramic femoral head. A multicenter survivorship study. J Bone Joint Surg. 2003; 85-A(5): 825-830.PubMed

Amanatullah DF, Landa J, Strauss EJ, Garino JP, Kim SH, Di Cesare PE. Comparison of surgical outcomes and implant wear between ceramic-ceramic and ceramic-polyethylene articulations in total hip arthroplasty. J Arthroplasty. 2011; 26(6 Suppl): 72-77.CrossRefPubMed

Boutin P, Christel P, Dorlot JM, et al. The use of dense alumina-alumina ceramic combination in total hip replacement. J Biomed Mater Res. 1988; 22(12): 1203-1232.CrossRefPubMed

Chotai PN, Su EP. Fracture of a titanium sleeve-encased third-generation ceramic liner in a modern THA. Orthopedics. 2011; 34(10): e682-e684.PubMed

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(4): 390-397.CrossRefPubMed

D'Antonio JA, Capello WN, Manley MT, Naughton M, Sutton K. A titanium-encased alumina ceramic bearing for total hip arthroplasty: 3- to 5-year results. Clin Orthop Relat Res. 2005; 441(441): 151-158.CrossRefPubMed

Fritsch EW, Gleitz M. Ceramic femoral head fractures in total hip arthroplasty. Clin Orthop Relat Res. 1996; 328(328): 129-136.CrossRefPubMed

Huet R, Sakona A, Kurtz SM. Strength and reliability of alumina ceramic femoral heads: Review of design, testing, and retrieval analysis. J Mech Behav Biomed Mater. 2011; 4(3): 476-483.CrossRefPubMed

10.

Jarrett CA, Ranawat AS, Bruzzone M, Blum YC, Rodriguez JA, Ranawat CS. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am. 2009; 91(6): 1344-1349.CrossRefPubMed

11.

Kempf I, Semlitsch M. Massive wear of a steel ball head by ceramic fragments in the polyethylene acetabular cup after revision of a total hip prosthesis with fractured ceramic ball. Arch Orthop Trauma Surg. 1990; 109(5): 284-287.CrossRefPubMed

12.

Mai K, Verioti C, Ezzet KA, Copp SN, Walker RH, Colwell CW Jr. Incidence of 'squeaking' after ceramic-on-ceramic total hip arthroplasty. Clin Orthop Relat Res. 2010; 468(2): 413-417.CrossRefPubMedCentralPubMed

13.

Matziolis G, Perka C, Disch A. Massive metallosis after revision of a fractured ceramic head onto a metal head. Arch Orthop Trauma Surg. 2003; 123(1): 48-50.PubMed

14.

Meftah M, Ebrahimpour PB, He C, Ranawat AS, Ranawat CS. Preliminary clinical and radiographic results of large ceramic heads on highly cross-linked polyethylene. Orthopedics. 2011; 34(6): 133.PubMed

15.

Murali R, Bonar SF, Kirsh G, Walter WK, Walter WL. Osteolysis in third-generation alumina ceramic-on-ceramic hip bearings with severe impingement and titanium metallosis. J Arthroplasty. 2008; 23(8): 1240.e13-e19.

16.

Nevelos J, Ingham E, Doyle C, et al. Microseparation of the centers of alumina-alumina artificial hip joints during simulator testing produces clinically relevant wear rates and patterns. J Arthroplasty. 2000; 15(6): 793-795.CrossRefPubMed

17.

Orradre Burusco I, Romero R, Brun M, Lopez Blasco JJ. Cross-linked ultra-high-molecular weight polyethylene liner and ceramic femoral head in total hip arthroplasty: a prospective study at 5 years follow-up. Arch Orthop Trauma Surg. 2011; 131(12): 1711-1716.CrossRefPubMed

18.

Ranawat AS, Ranawat CS. The squeaking hip: a cause for concern-agrees. Orthopedics. 2007; 30(9): 738-743.PubMed

19.

Restrepo C, Parvizi J, Kurtz SM, Sharkey PF, Hozack WJ, Rothman RH. The noisy ceramic hip: is component malpositioning the cause? J Arthroplasty. 2008; 23(5): 643-649.CrossRefPubMed

20.

Sedel L. Evolution of alumina-on-alumina implants: a review. Clin Orthop Relat Res. 2000; 379(379): 48-54.CrossRefPubMed

21.

Sharma V, Ranawat AS, Rasquinha VJ, Weiskopf J, Howard H, Ranawat CS. Revision total hip arthroplasty for ceramic head fracture: a long-term follow-up. J Arthroplasty. 2010; 25(3): 342-347.CrossRefPubMed

22.

Walter WL, O'Toole GC, Walter WK, Ellis A, Zicat BA. Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplasty. 2007; 22(4): 496-503.CrossRefPubMed

23.

Willmann G. Ceramic femoral head retrieval data. Clin Orthop Relat Res. 2000; 379(379): 22-28.CrossRefPubMed

Title: Ceramic Liner Fracture and Impingement in Total Hip Arthroplasty
Authors: Amy Steinhoff, MD
Victor Hakim, MD
Richard H. Walker, MD
Clifford W. Colwell Jr., MD
Steven N. Copp, MD
Publication date: 01-02-2015
Publisher: Springer US
Published in: HSS Journal ® / Issue 1/2015
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-014-9415-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ceramic Liner Fracture and Impingement in Total Hip Arthroplasty

Abstract

Background

Questions/Purposes

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/Purposes

Methods

Results

Conclusion

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