Skip to main content
Log in

Is There a Risk in Placing a Ceramic Head on a Previously Implanted Trunion?

  • Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®



Strategies for revising a ceramic-on-ceramic total hip prosthesis are controversial. Some consider reimplantation of a ceramic head on a well-fixed femoral stem inadvisable as it may lead to a fracture of the newly implanted head.


We assessed (1) the risk of fracture when a new ceramic head was placed on a previously implanted trunion; (2) the survival rate of the revised hips; and (3) hip function and acetabular and femoral component loosening at midterm followup.

Patients and Methods

We retrospectively reviewed all 126 patients (139 hips) who had revision of alumina-alumina hip arthroplasties between January 1977 and December 2005. Of these, 99 patients (110 hips) had revision of the socket only with retention of the femoral component. The femoral head was left in place in 33 hips, the same alumina head was re-implanted in seven hips, a new alumina head was implanted in 45 hips, a metallic head in 16, and a zirconia head in nine. Twenty-six patients (29 hips) died and nine (10 hips) were lost to followup before 5 years; this left 71 hips for review. Minimum followup was 60 months (mean, 112 months; range, 60–319 months).


Eighteen hips required rerevision surgery, 11 for aseptic loosening, two for septic loosening, two for fracture of a ceramic liner, one for recurrent dislocation, one for ipsilateral femoral fracture, and one for unexplained pain. Among the 61 ceramic heads implanted on a well-fixed stem, no fracture of the head occurred at a mean 88 months’ followup. The survival rate at 10 years with mechanical failure as the end point was 81.6%.


We observed no fractures of the ceramic heads implanted on a previous titanium trunion. This approach is possible if inspection shows no major imperfection of the Morse taper.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1A–B

Similar content being viewed by others


  1. Allain J, Roudot-Thoraval F, Delecrin J, Anract P, Migaud H, Goutallier D. Revision total hip arthroplasty performed after fracture of a ceramic femoral head: a multicenter survivorship study. J Bone Joint Surg Am. 2003;85:825–830.

    PubMed  Google Scholar 

  2. Baek SH, Kim SY. Cementless total hip arthroplasty with alumina bearings in patients younger than fifty with femoral head osteonecrosis. J Bone Joint Surg Am. 2008;90:1314–1320.

    Article  PubMed  Google Scholar 

  3. Bizot P, Hannouche D, Nizard R, Witvoet J, Sedel L. Hybrid alumina total hip arthroplasty using a press-fit metal-backed socket in patients younger than 55 years: a six- to 11-year evaluation. J Bone Joint Surg Br. 2004;86:190–194.

    Article  CAS  PubMed  Google Scholar 

  4. Bizot P, Nizard R, Hamadouche M, Hannouche D, Sedel L. Prevention of wear and osteolysis: alumina-on-alumina bearing. Clin Orthop Relat Res. 2001;393:85–93.

    Article  PubMed  Google Scholar 

  5. Bohler M, Mochida Y, Bauer TW, Plenk H Jr, Salzer M. Wear debris from two different alumina-on-alumina total hip arthroplasties. J Bone Joint Surg Br. 2000;82:901–909.

    Article  CAS  PubMed  Google Scholar 

  6. Brown C, Williams S, Tipper JL, Fisher J, Ingham E. Characterisation of wear particles produced by metal on metal and ceramic on metal hip prostheses under standard and microseparation simulation. J Mater Sci Mater Med. 2007;18:819–827.

    Article  CAS  PubMed  Google Scholar 

  7. Christel PS. Biocompatibility of surgical-grade dense polycrystalline alumina. Clin Orthop Relat Res. 1992;282:10–18.

    PubMed  Google Scholar 

  8. Clarke IC, Gustafson A, Jung H, Fujisawa A. Hip-simulator ranking of polyethylene wear: comparisons between ceramic heads of different sizes. Acta Orthop Scand. 1996;67:128–132.

    CAS  PubMed  Google Scholar 

  9. D’Antonio J, McCarthy JC, Bargar WL, Borden LS, Cappelo WN, Collis DK, Steinberg ME, Wedge JH. Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1993;296:133–139.

    PubMed  Google Scholar 

  10. D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126–137.

    PubMed  Google Scholar 

  11. D’Aubigné RM, Postel M. Cotation chiffrée de la fonction de la hanche. Rev Chir Orthop Reparatrice Appar Mot. 1970;56:481–486.

    Google Scholar 

  12. Ebramzadeh E, Sangiorgio SN, Lattuada F, Kang JS, Chiesa R, McKellop HA, Dorr LD. Accuracy of measurement of polyethylene wear with use of radiographs of total hip replacements. J Bone Joint Surg Am. 2003;85:2378–2384.

    PubMed  Google Scholar 

  13. Figueiredo-Pina CG, Yan Y, Neville A, Fisher J. Understanding the differences between the wear of metal-on-metal and ceramic-on-metal total hip replacements. Proc Inst Mech Eng H. 2008;222:285–296.

    CAS  PubMed  Google Scholar 

  14. Fye MA, Huo MH, Zatorski LE, Keggi KJ. Total hip arthroplasty performed without cement in patients with femoral head osteonecrosis who are less than 50 years old. J Arthroplasty. 1998;13:876–881.

    Article  CAS  PubMed  Google Scholar 

  15. Gore SM. Assessing methods—survival. Br Med J (Clin Res Ed). 1981;283:840–843.

    Article  CAS  Google Scholar 

  16. Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.

    PubMed  Google Scholar 

  17. Gualtieri G, Nigrisoli M, Dallari D, Catamo L, Gualtieri I. A study of the mechanical and biological behavior of bioceramic hip arthroplasty followed-up after more than 10 years. Chir Organi Mov. 1993;78:213–222.

    CAS  PubMed  Google Scholar 

  18. Hamadouche M, Boutin P, Daussange J, Bolander ME, Sedel L. Alumina-on-alumina total hip arthroplasty: a minimum 18.5-year follow-up study. J Bone Joint Surg Am. 2002;84:69–77.

    PubMed  Google Scholar 

  19. Hannouche D, Hamadouche M, Nizard R, Bizot P, Meunier A, Sedel L. Ceramics in total hip replacement. Clin Orthop Relat Res. 2005;430:62–71.

    Article  PubMed  Google Scholar 

  20. Hannouche D, Nich C, Bizot P, Meunier A, Nizard R, Sedel L. Fractures of ceramic bearings: history and present status. Clin Orthop Relat Res. 2003;417:19–26.

    PubMed  Google Scholar 

  21. Huo MH, Martin RP, Zatorski LE, Keggi KJ. Ceramic total hip replacement done without cement: long term follow-up study. Orthop Trans. 1995;19:400–401.

    Google Scholar 

  22. Ilchmann T, Neher S, Maurer F, Weise K. Modes of failure of a threaded acetabular cup: a radiographic study with EBRA of 42 revised cups. Int Orthop. 2007;31:211–216.

    Article  PubMed  Google Scholar 

  23. Jarrett CA, Ranawat AS, Bruzzone M, Blum YC, Rodriguez JA, Ranawat CS. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am. 2009;91:1344–1349.

    Article  PubMed  Google Scholar 

  24. Kempf I, Semlitsch M. 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. 1990;109:284–287.

    Article  CAS  PubMed  Google Scholar 

  25. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990;72:518–528.

    CAS  PubMed  Google Scholar 

  26. Mai K, Verioti C, Ezzet KA, Copp SN, Walker RH, Colwell CW Jr. Incidence of “squeaking after ceramic-on-ceramic total hip arthroplasty. Clin Orthop Relat Res. 2010;468:413–417.

    Article  PubMed  Google Scholar 

  27. Mittelmeier H, Heisel J. Sixteen-years’ experience with ceramic hip prostheses. Clin Orthop Relat Res. 1992;282:64–72.

    PubMed  Google Scholar 

  28. Nevelos JE, Prudhommeaux F, Hamadouche M, Doyle C, Ingham E, Meunier A, Nevelos AB, Sedel L, Fisher J. Comparative analysis of two different types of alumina-alumina hip prosthesis retrieved for aseptic loosening. J Bone Joint Surg Br. 2001;83:598–603.

    CAS  PubMed  Google Scholar 

  29. Nizard R, Sedel L, Hannouche D, Hamadouche M, Bizot P. Alumina pairing in total hip replacement. J Bone Joint Surg Br. 2005;87:755–758.

    Article  CAS  PubMed  Google Scholar 

  30. Nizard RS, Sedel L, Christel P, Meunier A, Soudry M, Witvoet J. Ten-year survivorship of cemented ceramic-ceramic total hip prosthesis. Clin Orthop Relat Res. 1992;282:53–63.

    PubMed  Google Scholar 

  31. Prudhommeaux F, Hamadouche M, Nevelos J, Doyle C, Meunier A, Sedel L. Wear of alumina-on-alumina total hip arthroplasties at a mean 11-year followup. Clin Orthop Relat Res. 2000;379:113–122.

    Article  PubMed  Google Scholar 

  32. Pulliam IT, Trousdale RT. Fracture of a ceramic femoral head after a revision operation: a case report. J Bone Joint Surg Am. 1997;79:118–121.

    CAS  PubMed  Google Scholar 

  33. Pupparo F, Engh CA. Comparison of porous-threaded and smooth-threaded acetabular components of identical design: two- to four-year results. Clin Orthop Relat Res. 1991;271:201–206.

    PubMed  Google Scholar 

  34. Walter WL, Waters TS, Gillies M, Donohoo S, Kurtz SM, Ranawat AS, Hozack WJ, Tuke MA. Squeaking hips. J Bone Joint Surg Am. 2008;90(Suppl 4):102–111.

    Article  PubMed  Google Scholar 

  35. Willmann G. Ceramics for total hip replacement—what a surgeon should know. Orthopedics. 1998;21:173–177.

    CAS  PubMed  Google Scholar 

  36. Willmann G. Ceramic femoral head retrieval data. Clin Orthop Relat Res. 2000;379:22–28.

    Article  PubMed  Google Scholar 

  37. Yoo JJ, Kim YM, Yoon KS, Koo KH, Song WS, Kim HJ. Alumina-on-alumina total hip arthroplasty: a five-year minimum follow-up study. J Bone Joint Surg Am. 2005;87:530–535.

    Article  PubMed  Google Scholar 

Download references


We thank Ines Sherifi MD (Laboratoire de Recherches Orthopédiques [UMR CNRS 7052], Paris, France) for her careful review of this manuscript.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Didier Hannouche MD, PhD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Hôpital Lariboisière.

About this article

Cite this article

Hannouche, D., Delambre, J., Zadegan, F. et al. Is There a Risk in Placing a Ceramic Head on a Previously Implanted Trunion?. Clin Orthop Relat Res 468, 3322–3327 (2010).

Download citation

  • Published:

  • Issue Date:

  • DOI: