Abstract
A case of a fractured ceramic femoral head without subsequent trauma, 14 months after a primary total hip arthroplasty, in a 40-year-old woman with hip dysplasia is reported. Intraoperative findings were multifragment femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After the removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt–chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At 22-month follow-up examination, the patient had no pain, used no walking aids and had normal activity.
Résumé
Nous rapportons un cas de fracture de tête céramique survenue sans notion traumatique 14 mois après une arthroplastie totale de hanche de première intention pour dysplasie chez une jeune femme de 40 ans. L’exploration per-opératoire a mis en évidence une fracture multifragmentaire de la tête, un insert polyéthylène endommagé, une métallose diffuse et une usure du cône métallique. La tige et l’implant acétabulaire étaient stables. Après ablation des fragments de céramique, excision de la métallose, et un lavage soigneux de l’articulation, un insert du même type a été mis en place et une tête métallique placée sur le cône de la tige. Au recul de 22 mois le patient est asymptomatique, marche sans canne et mène une activité normale.
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References
Allain J, Goutallier D, Voisin MC, Lemouel S (1998) Failure of a stainless steel femoral head of a revision total hip arthroplasty performed after a fracture of a ceramic femoral head. A case report. J Bone Joint Surg 80-A:1355–1360
Allain J, Roudot-Thoraval F, Delecrin J, Anract P, Migaud H, Goutalier D (2003) Revision total hip arthroplasty performed after fracture of a ceramic femoral head. J Bone Joint Surg 85-A:825–830
Arenas A, Tejero A, Garbayo A, Arias C, Barbadillo J, Lecumberri J (1999) Ceramic femoral head fractures in total hip replacement. Int Orthop 23:351–352
Burckhardt A, Berberat C (1993) How safe are ceramic heads as hip endoprostheses? A series of three head fractures within 3 months. Arch Orthop Trauma Surg 112:215–219
Callaway GH, Flynn W, Ranawat CS, Sculco TP (1995) Fracture of the femoral head after ceramic-on-polyethylene total hip arthroplasty. J Arthroplasty 10:855–859
Connes H (2003) Des déclarations à la matériovigilance aux décisions de la CNM. Revue de Chirurgie Orthopédique 89:49
Dambreville A (2003) Conduite chirurgicale pratique proposée aux chirurgiens confrontés au problème. Revue de Chirurgie Orthopédique 89:51
Davidson JA (1993) Characteristics of metal and ceramic total hip bearing surfaces and their effect on long-term ultra high molecular weight polyethylene wear. Clin Orthop 294:361–378
Fritsch E, Gleitz M (1996) Ceramic femoral head fractures in total hip arthroplasty. Clin Orthop 328:129–136
Hannouche D, Nich C, Bizot P, Meunier A, Nizard R, Sedel L (2003) Fractures of ceramic bearings. Clin Orthop 417:19–26
Higuchi F, Shiba N, Inoue A, Wakebe I (1995) Fracture of an alumina ceramic head in total hip arthroplasty. J Arthroplasty 10:851–854
Holmer P, Nielsen PT (1993) Fracture of a ceramic femoral head in total hip arthroplasty. J Arthroplasty 8:567–571
Kempf I, Semlitsch M (1990) Massive wear of a steel ball head by ceramic fragments in the polyethylene acetabular cup after revision of a total hip prosthesis with fractured ceramic ball. Arch Orthop Trauma Surg 109:284–287
Krikler S, Schatzker J (1995) Ceramic head failure. J Arthroplasty 10:860–862
Mangione P, Pascarel X, Vinciguerra B, Honton JL (1994) Fracture of the ceramic head in total hip prosthesis. Apropos of 2 cases. Int Orthop 18:359–362
Matziolis G, Perka C, Dish A (2003) Massive metallosis after revision of a fractured ceramic head onto a metal head. Arch Orthop Trauma Surg 123:48–50
McLean CR, Dabis H, Mok D (2002) Delayed fracture of the ceramic femoral head after trauma. J Arthroplasty 17:503–504
Michaud RJ, Rashad SY (1995) Spontaneous fracture of the ceramic ball in a ceramic–polyethylene total arthroplasty. J Arthroplasty 10:863–867
Moreschini O, Braidotti P (1991) Traumatic breakage of the ceramic head of prosthesis in total hip replacement. Ital J Orthop Traumatol 17:339–343
Nizard RS, Sedel L, Christel P, Meunier A, Soudry M, Witvoet J (1992) Ten-year survivorship of cemented ceramic–ceramic total hip prosthesis. Clin Orthop 282:53–63
Otsuka NY, Schatzker J (1994) A case of fracture of a ceramic head in total hip arthroplasty. Arch Orthop Trauma Surg 113:81–82
Peiro A, Pardo J, Navarrete R, Rodríguez-Alonso L, Martos F (1991) Fracture of the ceramic head in total hip arthroplasty. Report of two cases. J Arthroplasty 6:371–374
Piconi C, Labanti M, Magnani G, Caporale M, Maccauro G, Magliocchetti G (1999) Analysis of a failed alumina THR ball head. Biomaterials 20:1637–1646
Pulliam I, Trousdale R (1997) Fracture of a ceramic femoral head after a revision operation. J Bone Joint Surg 79-A:118–121
Wenda K, Ritter G, Rudig L (1993) Therapy of burst ceramic head of a hip prosthesis. Aktuelle Traumatol 23:294–296
Willmann G (2000) Ceramic femoral head retrieval data. Clin Orthop 379:22–28
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Panagopoulos, A., Megas, P., Tyllianakis, M. et al. Ceramic femoral head fracture with massive metallosis and severe wear of the cone: a case report and review of the literature. Eur J Orthop Surg Traumatol 16, 55–59 (2006). https://doi.org/10.1007/s00590-005-0025-4
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DOI: https://doi.org/10.1007/s00590-005-0025-4