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Ceramic Liner Fracture and Impingement in Total Hip Arthroplasty

  • Original Article
  • Published:
HSS Journal ®

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.

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Disclosures

Conflict of Interest

Amy Steinhoff, MD, Victor Hakim, MD, and Richard Walker, MD have declared that they have no conflict of interest. Clifford W. Colwell, Jr., MD reports personal fees and research support from Medical Compression Systems and research support from Stryker and Novartis, outside the work. Steven N. Copp, MD reports other from Nuvasive and Stryker, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Kaiser Permanente, San Diego, CA, USA

    Amy Steinhoff MD

  2. Hakim Joint Replacement, Plano, TX, USA

    Victor Hakim MD

  3. Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS116, La Jolla, CA, 92037, USA

    Richard H. Walker MD, Clifford W. Colwell Jr. MD & Steven N. Copp MD

  4. Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, USA

    Clifford W. Colwell Jr. MD

Authors
  1. Amy Steinhoff MD
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  2. Victor Hakim MD
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  3. Richard H. Walker MD
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  4. Clifford W. Colwell Jr. MD
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  5. Steven N. Copp MD
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Corresponding author

Correspondence to Steven N. Copp MD.

Additional information

Level of Evidence: Level IV - Case series (no, or historical, control group)

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Steinhoff, A., Hakim, V., Walker, R.H. et al. Ceramic Liner Fracture and Impingement in Total Hip Arthroplasty. HSS Jrnl 11, 50–55 (2015). https://doi.org/10.1007/s11420-014-9415-7

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  • DOI: https://doi.org/10.1007/s11420-014-9415-7

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