Revision Surgery After Fractures of Ceramic Components
Ceramic on Ceramic (CoC) bearings for Total Hip Arthroplasty (THA) were introduced with the aim of reducing wear associated with polyethylene (PE) components, thus limiting osteolysis and increasing the longevity of the implant especially in young and active patients. While this material offers great durability, fractures of the ceramics compounds remains a cause for concern, since can lead to catastrhopic failures and complications after revision. The prevalence of ceramics fractures ranges from 0.009% to 0.126%, with liner fractures being more frequent. The most common causes of fractures are fatigure of the components, malopistioning or mishandling. The clinical picture of an head fracture is straightforward; however, liner fractures can be more subtle and needs proper investigations. Once the diagnosis of ceramic fracture is made, revision surgery should not be postponed, but rather planned with ‘relative emergency’, because of the risk of fragments spreading in the soft tissues and further damaging the metal components. A debridement of the articular soft tissues with removal of cermaics fragments is mandatory in revision surgery. All damaged or malpositioned implant components should be revised and a new ceramic head and polyethilene or ceramic liner should be the beraing option. Metal heads and liners are definitively contraindicated. This chapter is aimed to present an evidence based, updated approach on how to prevent and treat this rare but devasting complication including diagnostic and surgical tips and tricks, considering risk factors and reason for failure.
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