Unusual prosthetic femoral head fracture in total hip arthroplasty: ceramic on polyethylene articulation

Tucker, Damien; Acharya, Mehool

doi:10.1136/bcr-2013-202685

Cited by 11 publications

(14 citation statements)

References 12 publications

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“…The high cobalt levels generated through the alumina abrasive condition is unlikely to be encountered clinically, although instances of ceramic head fracture in vivo have been reported leading to substantial damage of the polyethylene liner. 30 – 33 The damage generated in the heads produced a comparable surface roughness to that observed and commonly reported in retrieved components. 12 …”

Section: Discussionsupporting

confidence: 72%

The increase in cobalt release in metal-on-polyethylene hip bearings in tests with third body abrasives

Villiers

Traynor

Collins

et al. 2015

Proc Inst Mech Eng H

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Hypersensitivity reactions in patients receiving metal-on-metal hip replacements have been attributed to corrosion products as observed by elevated cobalt and chromium ions in the blood. Although the majority of cases are reported in metal-on-metal, incidences of these reactions have been reported in the metal-on-polyethylene patient population. To date, no in vitro study has considered cobalt release for this bearing combination. This study considered four 28 mm and seven 52 mm diameter metal-on-polyethylene bearings tested following ISO standard hip simulator conditions as well as under established abrasive conditions. These tests showed measurable cobalt in all bearings under standard conditions. Cobalt release, as well as polyethylene wear, increased with diameter, increasing from 52 to 255 ppb. The introduction of bone cement particles into the articulation doubled polyethylene wear and cobalt release while alumina particles produced significant damage on the heads demonstrated by cobalt levels of 70,700 ppb and an increased polyethylene wear from a mean value of 9–160 mm3/mc. Cobalt release was indicative of head damage and correlated with polyethylene wear at the next gravimetric interval. The removal of third body particles resulted in continued elevated cobalt levels in the 52 mm diameter bearings tested with alumina compared to standard conditions but the bearings tested with bone cement particles returned to standard levels. The polyethylene wear in the bone cement tested bearings also recovered to standard levels, although the alumina tested bearings continued to wear at a higher rate of 475 mm3/mc. Cobalt release was shown to occur in metal-on-polyethylene bearings indicating damage to the metal head resulting in increased polyethylene wear. While large diameter metal-on-polyethylene bearings may provide an increased range of motion and a reduced dislocation risk, increased levels of cobalt are likely to be released and this needs to be fully considered before being widely adopted.

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Section: Discussionsupporting

confidence: 72%

The increase in cobalt release in metal-on-polyethylene hip bearings in tests with third body abrasives

Villiers

Traynor

Collins

et al. 2015

Proc Inst Mech Eng H

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“…Ceramic implants were first used in THA by Boutin in the 1970s11). Ceramic-on-ceramic articulation has gained popularity due to its favorable properties (e.g., low wear rate, low friction coefficient)412). Ceramic materials are frequently preferred in prosthetic applications, especially in patients with long life expectancy.…”

Section: Discussionmentioning

confidence: 99%

“…The most important postoperative causes of ceramic fractures are trauma and hip dislocation6). However, atraumatic spontaneous fractures are not uncommon451516). Other risk factors for ceramic component fractures are high level of activity and obesity13).…”

Section: Discussionmentioning

confidence: 99%

“…Total hip arthroplasty (THA) is the standard approach for the surgical treatment of advanced stage coxarthrosis, particularly in elderly patients. Ceramic-on-ceramic articulation in total hip prosthesis has gained popularity due to some key advantages (e.g., minimal osteolysis, low wear rate, low coefficient of friction, corrosion resistance, excellent biocompatibility, and favorable lubrication characteristics), especially in young and active patients1234). However, the most important drawback to the use of this material during replacement surgery is that the ceramic, which has a high elastic modulus, breaks down without plastic deformation1).…”

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confidence: 99%

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Non-traumatic Ceramic Head Fracture in Total Hip Arthroplasty with Ceramic-on-Ceramic Articulation at Postoperative 16th Years

et al. 2019

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Ceramic articulation has gained popularity in total hip arthroplasty (THA); however, one of the most important concerns about the use of ceramic materials is the potential for breakage. Importantly, almost all ceramic fractures occur within the first six years after surgery. Here, we present a case report of a 52-year-old female patient who experienced an atraumatic ceramic head fracture at the 16th year after surgery. Key parameters that may be associated with ceramic head fracture are considered to be the use of a 28-mm head and high body mass index (BMI); the patient described here had a BMI of 34.3 kg/m 2 . Surgical treatment of the case included removal of the broken ceramic head and replacement with an alumina matrix composite ceramic head. At the 12th month follow-up visit, the patient was mobilized independently and could perform her daily activities. Ceramic head fracture after THA may occur even in late periods after surgery. For the treatment of fractures of ceramic material, the fractured component must be removed together with extensive soft tissue excision to ensure that no residual fragments are left behind.

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“…12 Tucker and Acharya documented a fracture of a zirconia ceramic femoral head on UHMWPE. 13 In 2006, Habermann et al reported three COP femoral head fractures with impingement of the femoral head, too vertical acetabular cup positioning, and manufacturing defects playing possible causative roles. 14 Finally, Nho et al described one zirconia-on-UHMWPE femoral head fracture.…”

Section: Discussionmentioning

confidence: 99%

Atraumatic Delta Head Fracture in a Ceramic-On-Polyethylene Total Hip Arthroplasty

et al. 2017

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A 47-year-old man underwent a left ceramic-on-polyethylene total hip arthroplasty with a delta ceramic femoral head. At 20 months postoperatively, he presented with acute left groin pain after he stepped over a fishing rod while on a boat. A fracture of the femoral head without trauma was diagnosed upon presentation. Manufacturing practices with improvements in each successive generation have decreased historically high ceramic fracture rates considerably. Although femoral head fractures have proven to be extremely rare both in ceramic-on-polyethylene articulations and with the newest delta femoral head, it is important to remain vigilant in all situations involving ceramics.

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Unusual prosthetic femoral head fracture in total hip arthroplasty: ceramic on polyethylene articulation

Cited by 11 publications

References 12 publications

The increase in cobalt release in metal-on-polyethylene hip bearings in tests with third body abrasives

The increase in cobalt release in metal-on-polyethylene hip bearings in tests with third body abrasives

Non-traumatic Ceramic Head Fracture in Total Hip Arthroplasty with Ceramic-on-Ceramic Articulation at Postoperative 16th Years

Atraumatic Delta Head Fracture in a Ceramic-On-Polyethylene Total Hip Arthroplasty

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