Late Onset Atraumatic Ceramic Head Fracture of a Hybrid Ceramic Bearings Total Hip Arthroplasty

Abstract

Ceramic head fracture is a major complication of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and though new generation ceramics have lowered the rates, although it is still a great concern. We report a case of late onset (more than 10 years after surgery) ceramic head fracture of a hybrid ceramic bearings to emphasize on its unusual clinical manifestation. Furthermore, we highlight the late onset presentation and also the rarity of this complication with this particular hybrid ceramic bearings. A relevant review of the literature revealed that hybrid ceramic bearings need to be more thoroughly studied to understand modes of their failure and to reach a consensus on how to reduce and prevent these disastrous complications.

Late Atraumatic Ceramic Head Fracture in Total Hip Arthroplasty: A Case Report

“…There are very few reported cases of late, atraumatic fracture of a ceramic femoral head. Papaioannou et al [ 1 ] reported on a 71-year-old female who was 11 years out from her index surgery. The implants were a third-generation 28-mm ceramic femoral head (alumina, Biolox Forte, CeramTec, Plochingen, Germany) with a fourth-generation ceramic liner (Biolox Delta, CeramTec, Plochingen, Germany).…”

“…The implants were a third-generation 28-mm ceramic femoral head (alumina, Biolox Forte, CeramTec, Plochingen, Germany) with a fourth-generation ceramic liner (Biolox Delta, CeramTec, Plochingen, Germany). Her risk factors were stated to be increased activity level, obesity, 28-mm ceramic head, and alumina on alumina matrix composite articulation, which is thought to cause low-temperature degradation of the zirconium [ 1 ].…”

“…Ceramic femoral head fracture is an uncommon rare but catastrophic complication of total hip arthroplasty (THA). The rate of this complication is as low as 0.001% for fourth-generation aluminum matrix composite designs [ 1 ]. However, the incidence of late (defined here as 10 years or more) atraumatic ceramic fracture is largely unknown.…”

“…However, the incidence of late (defined here as 10 years or more) atraumatic ceramic fracture is largely unknown. There are only four other reported cases [ 1 , 2 , 3 , 4 ]. Here, we account for a patient’s case of late, atraumatic ceramic femoral head fracture in the setting of a ceramic-on-ceramic THA.…”