Abstract
Improvements in ceramic materials, component design, and surgical technique have made ceramic bearing complications increasingly rare. However, when it happens, a fractured ceramic component can cause significant pain and morbidity following total hip arthroplasty (THA). The hard and sharp particulate debris from fractured ceramic components can cause damage to the existing hip prosthesis and jeopardise subsequent revision THA results due to third body wear.
Patients with ceramic fractures can 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.
Ceramic component fractures should be treated expeditiously. Revision options for failed ceramic components depend on existing component fixation, position, and locking mechanism and femoral trunnion integrity. In order to retain the implants, the components must be well-fixed, in good position, and have tapers and locking mechanisms that can accept new modular components. Additionally, an extensile exposure and complete synovectomy are necessary to remove as much of the sharp particulate debris. Finally, a new ceramic ball head with a titanium inner sleeve should be used in revisions for fractured ceramics due to their hardness and scratch resistance.
Early results for revision surgery for fractured ceramic components were inconsistent. Allain et al. reported on a series of 105 revisions performed for ceramic head fractures and found that the survivorship at 5 years was only 63%. The authors reported a high reoperation rate and also worse survivorship when the acetabular component was retained, a metal head was used for revisions, age younger than 50 years, and when a complete synovectomy was not performed at the time of revision. More recently, Sharma and colleagues reported on a series of 8 ceramic fractures revised to a metal-on-polyethylene articulation performed with a complete synovectomy. At 10-year follow-up, the authors reported on failures; increased wear; or lesser function compared to 6 matched patients undergoing revision using similar implants for other diagnoses. Others have also reported catastrophic failures when revising fractured ceramic components using metal ball heads.
In summary, ceramic bearing complications in THA are rare but catastrophic events. A systematic approach to evaluation and management is necessary to ensure a safe return.
