Survival of ceramic bearings in total hip replacement after high-energy trauma and periprosthetic acetabular fracture

Abstract

Surgeons remain concerned that ceramic hip prostheses may fail catastrophically if either the head or the liner is fractured. We report two patients, each with a ceramic-on-ceramic total hip replacement who sustained high-energy trauma sufficient to cause a displaced periprosthetic acetabular fracture in whom the ceramic bearings survived intact. Simultaneous fixation of the acetabular fracture, revision of the cementless acetabular prosthesis and exchange of the ceramic bearings were performed successfully in both patients. Improved methods of manufacture of new types of alumina ceramic with a smaller grain size, and lower porosity, have produced much stronger bearings. Whether patients should be advised to restrict high-impact activities in order to protect these modern ceramic bearings from fracture remains controversial.

Periprosthetic Fractures of the Acetabulum During Cup Insertion: Posterior Column Stability is Crucial

“…The purpose of this study was to evaluate outcomes and treatment strategies based on fracture pattern and stability. Previous reports have lacked a sufficiently large number of subjects to draw any significant conclusions [6,[10][11][12][13][14]. The first description of acetabular fractures around total hip arthroplasty was reported in 1972 [15].…”

Early failure of a non-cemented femoral stem after minimal-invasive total hip arthroplasty: cause analysis and classification

“…Cemented and non-cemented acetabular cups may fracture and dislocate [1,2], while fractures or dislocations of either polyethylene or ceramic liners may occur due to excessive loading [1,2]. Even the recently introduced highlinked polyethylene liners may crack [3].…”

“…Stem fractures may be further divided into fractures of a cemented or a non-cemented shaft. Fractures of cemented stems mostly seem to occur secondary after loosening or imprecise cementing techniques [1,2,4]. They may be further divided into fractures of modular and primary prostheses [5][6][7].…”

“…The most common reason for stem fracture seems to be due to wrong implant sizing or malpositioning in relation to the geometry of the femur [1,2,9,10]. The reported stem failures in these cases were almost all located in the middle to distal third of the stem, where the highest tensile stress values were calculated after loss of the proximal support [11].…”