Fracture of Ceramic Bearing Surfaces following Total Hip Replacement: A Systematic Review

Abstract

Ceramic bearing surfaces are increasingly used for total hip replacement, notwithstanding that concern is still related to ceramic brittleness and its possible mechanical failure. The aim of this systematic review is to answer three questions: (1) Are there risk factors for ceramic component fracture following total hip replacement? (2) Is it possible to perform an early diagnosis of ceramic component failure before catastrophic fracture occurs? (3) Is it possible to draw guidelines for revision surgery after ceramic components failure? A PubMed and Google Scholar search was performed and reference citations from publications identified in the literature search were reviewed. The use of 28 mm short-neck femoral head carries an increased risk of fracture. Acetabular component malposition might increase the risk of ceramic liner fractures. Synovial fluid microanalysis and CT scan are promising in early diagnosis of ceramic head and liner failure. Early revision is suggested in case of component failure; no consensus exists about the better coupling for revision surgery. Ceramic brittleness remains a major concern. Due to the increased number of ceramic on ceramic implants, more revision surgeries and reports on ceramic components failure are expected in the future. An algorithm of diagnosis and treatment for ceramic hip failure is proposed.

The Survival Analysis in Third-Generation Ceramic-On-Ceramic Total Hip Arthroplasty

“…In our opinion, this might have caused edge loading and/or stress concentration in the peripheral portion of the liner resulting from hyperflexion and wide abduction [17]. Likewise, Traina et al [26] in their review article of CoC THA, said that the accepted hypothesis as a causative factor for ceramic liner fracture is the cyclic impingement between the neck of the stem and the acetabular component.…”

Is There a Difference in Revision Risk Between Metal and Ceramic Heads on Highly Crosslinked Polyethylene Liners?

“…Theoretical advantages of ceramic compared with metal heads are that the smooth finish, hardness, and wettability lead to less friction, more lubrication, and less scratching between the bearing surfaces and thus lower rates of liner wear and osteolysis [37], although this is based on use of historical UHMWPE (gamma air-sterilized polyethylene) and older manufacturing processes of femoral heads that may not generalize to contemporary implants. One of the major concerns about ceramic heads, especially in ceramic-on-ceramic articulation, is the risk of component fracture; however, this has shown to be decreased in ceramic-on-polyethylene bearing surfaces [1,39]. Results from the Australian registry suggest that ceramic heads have a slightly higher revision risk among patients with osteoarthritis over a 10-year period when used with HXLPE (gender/age-adjusted hazard ratio [HR], 1.03; 95% confidence interval, 0.94-1.13) [28].…”

Metal-on-metal total hip arthroplasty: is there still a role in 2016?

“…CoC bearings have had mixed results throughout the literature, with early generations experiencing issues with ceramic fracture and squeaking [1]. The newest generation of ceramics exhibit an exceedingly low fracture risk [2,3], yet the squeaking hip continues to be an issue [4]. Ranawat et al reported 10.7 % of patients with CoC hips complained of audible squeaking [5].…”