Protrusion of a ceramic femoral head through the acetabular metallic cup in total-hip arthroplasty: A case report

Do Not Postpone Revision of Worn Conventional Liners in Ceramic-on-Polyethylene Total Hip Arthroplasty: A New Dramatic Failure

Catastrophic failure of ceramic-on-polyethylene total hip arthroplasty is still occasionally described. We report on a new case of complete atraumatic penetration of an intact ceramic head through the titanium cup in a cementless total hip arthroplasty due to dramatic polyethylene and metal wear. We reviewed the literature for similar cases and analyzed potential risk factors. Most importantly, revision of radiologically worn liners should not be postponed, especially in young and active patients with conventional liners, because the time to dramatic failure could be shorter than expected.

Catastrophic failure and metallosis of the acetabular component in total hip arthroplasty

Background

To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis.

Methods

Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification.

Results

The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised.

Conclusions

Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.