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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


Ceramic bearing complications are a rare, but can be catastrophic, complication following total hip arthroplasty (THA). Particulate debris from these failed bearings can cause damage the underlying femoral and acetabular components and/or cause further damage to future hip implants. Failure to recognise and appropriately manage these events can lead to significant morbidity.

Ceramic component fractures should be treated expeditiously. Delays in diagnosis and treatment can result in destructive damage of the underlying hip prosthesis caused by sharp, abrasive wear of ceramic particles. Patients with ceramic fractures present with sudden onset of pain and dysfunction. Often, the patient will report a noisy hip articulation. Radiographs can range from subtle densities surrounding the hip implant to complete disintegration and loss of sphericity of the femoral head or acetabular liner. As with any other causes of failed joint arthroplasty, a systematic evaluation and workup for failure is mandatory prior to revision surgery.

Revision options for failed ceramic components depend on component fixation, position, and type. In order to retain existing implants, the components must be well fixed, appropriately positioned, and have tapers that are undamaged and can accept current femoral heads. If these conditions are not met, then revision of components should be performed to optimise outcomes. Additionally, an extensile exposure is necessary in order to perform a complete synovectomy in order to remove as much of the ceramic particulate debris. Finally, the question of optimal bearing choice following component revision remains an area of debate. Newer, alumina composite ceramic ball heads are harder and more scratch resistant that metal ball heads and therefore preferred in my personal practice.

In summary, ceramic bearing complications are rare but catastrophic events. A systematic approach to evaluation and management is necessary to ensure a safe return.