The Reliability of Modern Alumina Bearings in Total Hip Arthroplasty

Ceramic fragmentation after total hip arthroplasty: two case reports and literature review

Background

Ceramic fragmentation is a rare but serious complication after total hip arthroplasty (THA). We reviewed the PubMed literature from 1990 to 2023 and found only 31 case reports of ceramic fragmentation after THA. Our case reports help to expand understanding of this rare complication. We shared our surgical experience and identified an ideal material for revision surgery, which can serve as a useful reference for other orthopedic surgeons to perform ceramic fragmentation revision surgery in the future. We also analyzed the possible causes, diagnosis, and treatment opinions of ceramic fragmentation.

Case presentation

This study presents two cases of ceramic fragmentation after THA. One patient had ceramic head fragmentation 10 years after the primary THA, and one patient had ceramic liner fragmentation 5 years after the primary THA. Both patients presented with pain, and one patient also reported a clicking sound in the hip. The two patients described here had BMIs of 23.7 and 23.1, respectively. Both patients' ceramic fragmentation were due to aseptic loosening, not periprosthetic joint infections, as confirmed by negative microbiological cultures. Radiographic examinations of both patients revealed radio-opaque wear debris around the hip joint prostheses and we describe the surgical protocols and intraoperative findings in both cases in detail.

Conclusion

Our cases and the literature suggest that ceramic fragmentation can occur at any time after THA. The most immediate symptoms are pain and noise, but some patients may be asymptomatic. Ceramic on polyethylene bearings is recommended for revision surgery whenever possible; metal bearings should be avoided.

Effect of Operation Room Nursing Intervention and Ceramic Prosthesis on Total Hip Arthroplasty

In order to solve the problems of large trauma, many postoperative complications, and complex operation of artificial hip arthroplasty, a method to analyze the application effect of operating room nursing intervention in artificial hip arthroplasty was proposed. Firstly, 120 patients who underwent hip arthroplasty in our hospital from January to December 2017 were selected; Secondly, they were randomly divided into routine group (60 cases) and intervention group (60 cases); finally, on this basis, the intervention group strengthened the nursing in the operating room and used nanoceramic prosthesis. The Harris score of hip joint, the incidence of postoperative complications, and the satisfaction with nursing services were compared between the two groups. The results showed that the Harris score of hip joint and the satisfaction score of nursing service in the intervention group were significantly higher than those in the routine group (P < 0.05); the incidence of postoperative complications in the intervention group was significantly lower than that in the routine group (P < 0.05). It is proved that actively carrying out nursing intervention in the operating room and using nanoceramic prosthesis can not only improve the clinical efficacy and nursing service satisfaction of patients undergoing total hip arthroplasty but also reduce the incidence of complications.

Ceramic liner fracture in ceramic on ceramic Total hip arthoplasty: A case report

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A case of ceramic linear fracture without trauma.

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Ceramic with polyethylene bearing could be a good choice after ceramic on ceramic liner fracture.

Introduction

Revision rates of total hip arthoplasty have decreased after introducing total hip arthroplasty using ceramic component due to reduce wear and osteolysis.

Case report

29 year old male case of bilateral hip avascular necrosis operated for bilateral hip THA presented 30 months after with complaint of squeaking, x-ray showing left ceramic liner fracture without any history of trauma. Revision of ceramic liner and head with ceramic on polyethylene was done.

Discussion and conclusion

Ceramic on ceramic articulation has the lowest wear rate among various articulations. However, there is a concern about ceramic implant fracture; therefore ceramic with polyethylene bearing could be a good choice.

Delayed diagnosis of catastrophic ceramic liner failure with resultant pelvic discontinuity and massive metallosis

With newer-generation ceramic components used in total hip arthroplasty, component fracture is a rare complication. However rare, when ceramic component fracture does occur, prompt identification and revision is necessary as delay can lead to dramatic failure with resultant metallosis as the extremely hard ceramic debris abrades remaining components. We present a case of a 70-year-old woman with ceramic liner fracture and an estimated 10-year delay in intervention with failure resulting in pelvic discontinuity and massive metallosis with associated cutaneous manifestation. She was treated with a complex revision and reconstruction and is 2 years postrevision without major complication.