Tips and tricks: Fracture of a ceramic insert with modern ceramic total hip replacement

Abstract

Results obtained with ceramic bearings in total hip arthroplasty have been disappointing because of increased component loosening rates primarily caused by design issues and use of low-quality ceramic, resulting in fracture and debris generation. Although new-generation ceramics have produced a reduced incidence of fracture, concerns still persist about the fracture of ceramic liners. After investigating the underlying cause of fracture in contemporary ceramic-on-ceramic bearings, we sought to determine the incidence of ceramic liner fracture and to formulate technical guidelines for avoiding catastrophic failure. Between January 2000 and January 2005, we prospectively studied a consecutive series of 147 patients (179 hips) who had undergone primary cementless total hip arthroplasty with modern ceramic-onceramic articulation so that we could detect ceramic liner fracture. The mean length of the follow-up period was 3.1 years (range, 2-6.5 years). By the latest follow-up examination, delayed ceramic liner fracture had occurred in 3 hips (1.7%). One liner was chipped during insertion because of eccentric seating of the liner. Head fracture occurred in 2 hips (1.1%). Despite the improved wear characteristics of modern ceramic-on-ceramic articulations, a catastrophic failure with ceramic liner failure was still observed during short-term follow-up monitoring. This finding prompted us to define important technical aspects to be considered to minimize ceramic liner fractures.