Ceramic liner fracture and impingement in total hip arthroplasty

Abstract

Background: Ceramic-on-ceramic bearing surfaces were developed to provide an alternate to metal-on-polyethylene to decrease wear-induced osteolysis in total hip arthroplasty patients. In an effort to decrease the risk of ceramic acetabular component fracture or damage during implantation, a raised metal rim was added.

Questions/purposes: How many fractures or impingements have occurred in our population of patients with ceramic liners with raised rims?

Methods: With IRB-approved consent, a case series was reviewed from a single center registry and 4 of 169 patients were identified who had revision hip surgery with the ceramic liner with a raised metal rim: one for ceramic liner fracture and three for metallosis, pain, and squeaking. Implant alignment and operative findings were reviewed.

Results: One ceramic liner fracture and three cases of metallosis from impingement of the femoral neck on the posterior elevated metal rim of the acetabular liner were observed at revision. The femoral neck in each patient had a divot that corresponded to a divot in the posterosuperior liner rim. Three of the four patients had audible squeaking or clicking prior to revision. A total of 3% of patients in this series had clinically significant impingement with this implant type.

Conclusion: Acoustic phenomenon in a ceramic on ceramic bearing surface should be investigated with a cross-table lateral radiograph to evaluate component position. If symptomatic impingement is demonstrated, revision should be considered to avoid failure from metallosis or fracture.

Keywords: acoustic phenomenon; ceramic bearing; ceramic fracture; metallosis; total hip arthroplasty.

Fig. 1

A raised metal rim was added in the Trident (Stryker, Mahwah, NJ) ceramic acetabular liner to decrease the risk of ceramic acetabular component fracture or damage during implantation.

Fig. 2

The liner fractured into many fragments displayed after removal from the hip.

Fig. 3

Cross-table lateral radiographs showed evidence of increased anteversion of the cup with abutment of the elevated metal acetabular rim on the femoral neck.

Fig. 4

a A divot in the femoral neck and a corresponding divot in the posterior raised metal rim of the ceramic liner were seen at the time of surgery. b A divot in the posterior aspect of the raised metal rim of the liner noted at the time of revision surgery.