Abstract
Introduction
A 68 year old female patient underwent a left total hip replacement for primary osteoarthritis in March 2004. She was referred back by her GP 5 years as she was struggling with mobility and felt there were mice in her hip. It was squeking so loudly that it could be hear at a distance of 25 metres. There was no history of any falls or dislocation in the last 5 years. The implant used was an Exeter/ABG ceramic total hip prosthesis with Palacos cement. This ladies discomfort in her hip had been always there. She never described herself as being satisfied with the THR. However, her discomfort had worsened terribly over the last year.
On examination
The slightest movement around her hip caused her severe pain. Tremendous squeaking could be heard when she was made to walk. She had significantly limb length discrepancy of 2.5cms. The radiographs revealed that she had probably broken the ceramic head as pieces could be seen around the neck area.
On table
When the hip was exposed through standard lateral approach it was found that the ceramic head was intact. There was a large amount of blackish debris around the entire area and the shell of the ABG cup had a huge defect in it. It was a strartling revelation as it was initially thought that the ceramic head was broken. Revision surgery was carried out with a C stem total hip prosthesis with an orthodynamic socket.
Discussion
Ceramic bearing surfaces have been introduced to reduce friction and prevent bone loss. There has been a problem with squeaky hips following ceramic implant insertion. However there has been no report of cup wear and an intact ceramic head till date in literature. To our knowledge this is the first case being reported and the images are quite startling.
