How to Treat Failures Related to Articulation

  • Luigi ZagraEmail author
  • Luca Bianchi
  • Roberto Giacometti Ceroni


Wear is the major reason of late failure of THA. Progressive osteolysis can produce loss of bone, implant failure, and difficulties in revision due to bone deficiency. This is the reason why the best “treatment” is to prevent failures related to articulation by employing low wear bearing surfaces and monitoring the patients. Troubles with materials teach that there is not an ideal solution for every case in THA and that the surgeon must select the proper tribology for each patient. The correct component position and orientation is critical for each coupling. A proper surgical technique and implant position remain crucial. Early revision improving the tribology can prevent catastrophic complications such as major bone loss or loosening. Major unnecessary surgery should be avoided and only the failed components should be revised. Malposition must be corrected. The center of rotation, off-set and bone stock should be restored whenever possible. Different options and how to face different situations in case of revision are analyzed in this paper.


Bone Stock Ceramic Head Ceramic Fragment Metal Head Ceramic Liner 
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  1.  1.
    Allain J, Roudot-Thoraval F, Delecrin J, Anract P, Migaud H, Goutallier D (2003) Revision total hip arthroplasty performed after fracture of a ceramic femoral head. A multicenter survivorship study. J Bone Joint Surg Am 85-A(5):825–830PubMedGoogle Scholar
  2.  2.
    Ball ST, Le Duff MJ, Amstutz HC (2007) Early results of conversion of a failed femoral component in hip resurfacing arthroplasty. J Bone Joint Surg Am 89(4):735–741PubMedCrossRefGoogle Scholar
  3.  3.
    Browne JA, Bechtold CD, Berry DJ, Hanssen AD, Lewallen DG (2010) Failed metal-on-metal hip arthroplasties: a spectrum of clinical presentations and operative findings. Clin Orthop Relat Res 468(9):2313–2320PubMedCrossRefGoogle Scholar
  4.  4.
    Clayton RA, Beggs I, Salter DM, Grant MH, Patton JT, Porter DE (2008) Inflammatory pseudotumor associated with femoral nerve palsy following metal-on-metal resurfacing of the hip. J Bone Joint Surg Am 90(9):1988–1993PubMedCrossRefGoogle Scholar
  5.  5.
    Dalla Pria P, Zagra L, Esopi P, Masoni D (2010) Breakage and noises in ceramic on ceramic couplings. Eur Orthop Traumatol 1:53–59CrossRefGoogle Scholar
  6.  6.
    Emms NW, Stockley I, Hamer AJ, Wilkinson JM (2010) Long-term outcome of a cementless, hemispherical, press-fit acetabular component: survivorship analysis and dose–response relationship to linear polyethylene wear. J Bone Joint Surg Br 92(6):856–861PubMedCrossRefGoogle Scholar
  7.  7.
    Girard J, Bocquet D, Autissier G, Fouilleron N, Fron D, Migaud H (2010) Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg Am 92(14):2419–2426PubMedCrossRefGoogle Scholar
  8.  8.
    Gozzini GA, Schmid C, Dalla Pria P (2002) Massive wear in CoCrMo head following the fracture of an alumina head. Hip Int 12:37–42Google Scholar
  9.  9.
    Grammatopoulos G, Pandit H, Kwon Y-M, Gundle R, McLardy-Smith P, Beard DJ, Murray DW, Gill HS (2009) Hip resurfacings revised for inflammatory pseudotumor have a poor outcome. J Bone Joint Surg Br 91-B:1019–1024CrossRefGoogle Scholar
  10. 10.
    Huo MH, Brown BS (2003) What’s new in hip arthroplasty. J Bone Joint Surg Am 85-A(9):1852–1864PubMedGoogle Scholar
  11. 11.
    Jacobs CA, Christensen CP, Greenwald AS, McKellop H (2007) Clinical performance of highly cross-linked polyethylenes in total hip arthroplasty. J Bone Joint Surg Am 89(12):2779–2786PubMedCrossRefGoogle Scholar
  12. 12.
    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(5):284–287PubMedCrossRefGoogle Scholar
  13. 13.
    Khanuja HS, Aggarwal A, Hungerford MW, Hungerford DS, Jones LC, Mont MA (2010) Cementing polyethylene liners into non-modular acetabular components in revision total hip arthroplasty. J Orthop Surg 18(2):184–188Google Scholar
  14. 14.
    Learmonth ID (2003) Biocompatibility: a biomechanical and biological concept in total hip replacement. Surgeon 1(1):1–8PubMedCrossRefGoogle Scholar
  15. 15.
    Lee SC, Jung KA, Nam CH, Kim TH, Ahn NK, Hwang SH (2010) Acetabular screw head-induced ceramic acetabular liner fracture in cementless ceramic-on-ceramic total hip arthroplasty. Orthopedics 33(5). doi: 10.3928/01477447-20100329-30
  16. 16.
    Leslie IJ, Williams S, Isaac G, Ingham E, Fisher J (2009) High cup angle and microseparation increase the wear of hip surface replacements. Clin Orthop Relat Res 467(9):2259–2265PubMedCrossRefGoogle Scholar
  17. 17.
    Lieberman JR, Moeckel BH, Evans BG, Salvati EA, Ranawat CS (1993) Cement-within-cement revision hip arthroplasty. J Bone Joint Surg 75 B:869–871Google Scholar
  18. 18.
    Lusty PJ, Watson A, Tuke MA, Walter WL, Walter WK, Zicat B (2007) Wear and acetabular component orientation in third generation alumina-on-alumina ceramic bearings: an analysis of 33 retrievals [corrected]. J Bone Joint Surg Br 89(9):1158–1164PubMedCrossRefGoogle Scholar
  19. 19.
    Mäkelä KT, Eskelinen A, Pulkkinen P, Paavolainen P, Remes V (2011) Results of 3,668 primary total hip replacements for primary osteoarthritis in patients under the age of 55 years. Acta Orthop 82(5):521–529PubMedCrossRefGoogle Scholar
  20. 20.
    Matziolis G, Perka C, Disch A (2003) Massive metallosis after revision of a fractured ceramic head onto a metal head. Arch Orthop Trauma Surg 123(1):48–50PubMedGoogle Scholar
  21. 21.
    McKellop HA, Campbell P, Park SH, Schmalzried TP, Grigoris P, Amstutz HC, Sarmiento A (1995) The origin of submicron polyethylene wear debris in total hip arthroplasty. Clin Orthop Relat Res 311:3–20PubMedGoogle Scholar
  22. 22.
    McKellop HA, Shen FW, Lu B, Campbell P, Salovey R (2000) Effect of sterilization method and other modifications on the wear resistance of acetabular cups made of ultra-high molecular weight polyethylene. A hip-simulator study. J Bone Joint Surg Am 82-A(12):1708–1725PubMedGoogle Scholar
  23. 23.
    Mueller LA, Voelk M, Kress A, Pitto RP, Schmidt R (2007) An ABJS best paper: progressive cancellous and cortical bone remodeling after press-fit cup fixation: a 3-year followup. Clin Orthop Relat Res 463:213–220PubMedGoogle Scholar
  24. 24.
    Murray DW, Grammatopoulos G, Gundle R, Gibbons CL, Whitwell D, Taylor A, Glyn-Jones S, Pandit HG, Ostlere S, Gill HS, Athanasou N, McLardy-Smith P (2011) Hip resurfacing and pseudotumour. Hip Int 21(3):279–283PubMedCrossRefGoogle Scholar
  25. 25.
    Onda K, Nagoya S, Kaya M, Yamashita T (2008) Cup-neck impingement due to the malposition of the implant as a possible mechanism for metallosis in metal-on-metal total hip arthroplasty. Orthopedics 31(4):396PubMedCrossRefGoogle Scholar
  26. 26.
    Pitto RP, Bhargava A, Pandit S, Walker C, Munro JT (2008) Quantitative CT-assisted osteodensitometry of femoral adaptive bone remodelling after uncemented total hip arthroplasty. Int Orthop 32(5):589–595PubMedCrossRefGoogle Scholar
  27. 27.
    Saito S, Ishii T, Mori S, Hosaka K, Ootaki M, Tokuhashi Y (2010) Long-term results of metasul metal-on-metal total hip arthroplasty. Orthopedics 11;3(8):3Google Scholar
  28. 28.
    Sharma V, Ranawat AS, Rasquinha VJ, Weiskopf J, Howard H, Ranawat CS (2010) Revision total hip arthroplasty for ceramic head fracture: a long-term follow-up. J Arthroplasty 25(3):342–347PubMedCrossRefGoogle Scholar
  29. 29.
    Tower SS, Currier JH, Currier BH, Lyford KA, Van Citters DW, Mayor MB (2007) Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg Am 89(10):2212–2217PubMedCrossRefGoogle Scholar
  30. 30.
    Traina F, Tassinari E, De Fine M, Bordini B, Toni A (2011) Revision of a ceramic hip for fractured ceramic components. J Bone Joint Surg Am 93(24):1471–1479.Google Scholar
  31. 31.
    Willert HG (2005) Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am 87(1):28–36PubMedCrossRefGoogle Scholar
  32. 32.
    Willert HG, Bertram H, Buchhorn GH (1990) Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles. Clin Orthop Relat Res 258:95–107PubMedGoogle Scholar
  33. 33.
    Young J, Vallamshetla VR, Lawrence T (2008) The polished tri-tapered stem for cement-in-cement revision hip arthroplasty, a reliable and reproducible technique? Hip Int 18(4):272–277PubMedGoogle Scholar

Copyright information

© EFORT 2012

Authors and Affiliations

  • Luigi Zagra
    • 1
    Email author
  • Luca Bianchi
    • 1
  • Roberto Giacometti Ceroni
    • 1
  1. 1.Hip department: Istituto Ortopedico Galeazzi IRCCSMilanItaly

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