Ceramic Liner Fracture in Total Hip Arthroplasty: A Report of 3 Cases

Abstract

The ceramic on ceramic (COC) bearing surface has been utilized in total hip arthroplasty (THA) for decades. Despite the outstanding tribology of ceramic materials, ceramic fracture has been reported. Patients treated with COC THA in our database between May 2008 and April 2013 were studied with the goal of identifying factors related to ceramic fractures. The inclusion criteria were patients with preoperative and postoperative radiographs available for evaluation. The exclusion criteria were patients who were lost to follow-up and revision surgery. A total of 197 hips were treated with COC THA (171 patients) that met the inclusion criteria. Three patients were diagnosed with postoperative ceramic fractures at 9 months, 30 months, and 42 months. Two of them were resulted from intraoperative errors, including malposition of cup and improper placement of ceramic liner. One was resulted from repeated extremes of range-of-motion (ROM) of involved hip joint that increased edge-loading during daily activity. Management of ceramic fracture needed an extensive synovectomy, through irrigation of intraarticular space for complete removal of ceramic fragments and reimplantation of liners.