Abstract
Ceramic bearing complications are rare, but can be a catastrophic complication following total hip arthroplasty (THA). Particulate debris from fractured ceramics can cause damage to the hip prosthesis and jeopardise subsequent revision THA. Patients with ceramic fractures can present with sudden onset of pain and dysfunction. Often, the patient will report a noisy hip articulation. Radiographs can range from subtle densities surrounding the hip implant to complete disintegration and loss of sphericity of the femoral head or acetabular liner.
Ceramic component fractures should be treated expeditiously. Revision options for failed ceramic components depend on existing component fixation, position, and type. In order to retain the implants, the components must be well fixed, appropriately positioned, and have tapers that are undamaged and can accept current femoral heads. Additionally, an extensile exposure and complete synovectomy are necessary to remove the sharp ceramic particulate debris. Finally, a ceramic ball head should be used to revise a fractured ceramic THA. Newer, alumina composite ceramic ball heads are harder, reliable, and more scratch resistant compared to metal ball heads. However, when retaining the femoral component, a ceramic ball head with a titanium sleeve should be used to prevent subsequent failures.
In summary, ceramic bearing complications are rare but catastrophic events. A systematic approach to evaluation and management is necessary to ensure a safe return.
