Complete wear-through of a metal-backed acetabular cup in an ambulatory patient

Abstract

We present a rare case of a patient who presented with complete and rapid wear-through of a ceramic femoral head through a polyethylene liner and titanium acetabular cup. In addition, this patient exhibited significantly elevated serum titanium ion levels, which may serve as a marker of severe metallosis in cases where the preoperative plain radiographs underestimate signs of periarticular metal debris. The unique findings of this case include the rapid (less than 1 year time) wear-through of the femoral head in interval radiographs and the dramatic progression of metallosis and pelvic and femoral osteolysis that required both component revision. In addition, the markedly elevated titanium levels secondary to cup wear-through are also of interest and demonstrate a systemic manifestation of abrasive wear of a titanium alloy component.

Do Not Postpone Revision of Worn Conventional Liners in Ceramic-on-Polyethylene Total Hip Arthroplasty: A New Dramatic Failure

“…Previous reports have suggested potential risk factors for accelerated polyethylene wear, such as high demand of young and active patients, conventional liners, liner thickness, wear at the metal-polyethylene interface, foreign body debris, cup positioning with increased inclination angle, cup design, and multiple joint replacements [ 1 , 2 , [7] , [8] , [9] , [10] , [11] ].…”

“…Polyethylene manufacturing seems to have a more critical role than the head material because thin and conventional liners were common findings among the cases regardless of the articulating head, and they might have mainly contributed to such catastrophic failures [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. Recent literature has demonstrated favorable long-term THA results using highly cross-linked polyethylene liners with different ceramic and metal heads in general populations, as well as in young patients showing low wear rates [ [15] , [16] , [17] , [18] , [19] , [20] ].…”

“…In all 12 cases, including the current case, cementless THAs using titanium cups were implanted. All of them have reported massive wear of polyethylene liners and metal cups, resulting in penetration of intact ceramic femoral heads [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. We reviewed each case, also considering the discussion by the authors in an attempt to identify common causes of such dramatic failure.…”

“…Catastrophic failure of ceramic-on-polyethylene total hip arthroplasty (THA) in the setting of massive material wear is still occasionally described as case reports [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. Despite continuous evolution in the manufacturing of arthroplasty materials, this mode of failure has not yet been eliminated, as all bearing surfaces will wear [ 14 ].…”

“…Here, we report on a new case of such dramatic failures, leaving the ceramic head unfractured. While reviewing the literature, 12 similar cases in 11 reports have been extracted [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. A detailed analysis of all cases, including our case, has been undertaken in this report.…”