Fracture of Ceramic Bearing Surfaces following Total Hip Replacement: A Systematic Review

Ceramic bearing surfaces are increasingly used for total hip replacement, notwithstanding that concern is still related to ceramic brittleness and its possible mechanical failure. The aim of this systematic review is to answer three questions: (1) Are there risk factors for ceramic component fracture following total hip replacement? (2) Is it possible to perform an early diagnosis of ceramic component failure before catastrophic fracture occurs? (3) Is it possible to draw guidelines for revision surgery after ceramic components failure? A PubMed and Google Scholar search was performed and reference citations from publications identified in the literature search were reviewed. The use of 28 mm short-neck femoral head carries an increased risk of fracture. Acetabular component malposition might increase the risk of ceramic liner fractures. Synovial fluid microanalysis and CT scan are promising in early diagnosis of ceramic head and liner failure. Early revision is suggested in case of component failure; no consensus exists about the better coupling for revision surgery. Ceramic brittleness remains a major concern. Due to the increased number of ceramic on ceramic implants, more revision surgeries and reports on ceramic components failure are expected in the future. An algorithm of diagnosis and treatment for ceramic hip failure is proposed.

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Ceramic bearings fracture: a literature review on risk factors, diagnosis, and treatment

Journal of Surgery and Trauma ◽

10.32592/jsurgery.2020.8.1.100 ◽

2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Keyword(s):

Risk Factors ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Young Patients ◽

Revision Arthroplasty ◽

Ceramic Component ◽

Total Hip ◽

Ceramic Bearing ◽

Ceramic Components

Ceramic surfaces are commonly used in total hip arthroplasty (THA) in young patients due to their good tribological properties. Nonetheless, the fracture of ceramic components is among the most demanding complications of total hip arthroplasty. Ceramic failure is a matter of emergency and needs urgent revision arthroplasty. In this regard, the present study aimed to better understand how to diagnose a ceramic component fracture, identify the major risk factors for the fracture of ceramic components, and analyze the different techniques used in revision arthroplasty for ceramic bearing failure. The literature search was performed on PubMed, MEDLINE-Ovid, and Cochrane Reviews. The search keywords included ceramic fracture, ceramic failure, and ceramic arthroplasty revision surgery. A number of 47 articles were selected out of 126 articles found in the initial research. X-ray and computed tomography (CT) scan must be utilized on suspicion of ceramic component fracture. The most relevant risk factor for head fracture is short neck and 28-mm head combination. Moreover, acetabular cup malpositioning and liner misalignment during insertion are the two major risk factors for liner fracture. There is no consensus on the best revision treatment strategy. Nonetheless, it is necessary to perform a complete synovectomy and an accurate cleaning of the hip joint before the implant of the new components. Stability, integrity, and positioning of both femoral and acetabular components must be evaluated during surgery. If damaged, even well-fixed components should be removed. New ceramic bearing surface is the best option, whereas metal is not recommended for revision surgery.

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The effectiveness of inpatient physical therapy compared to outpatient physical therapy for older adults after total hip replacement in the post-discharge period: a systematic review protocol

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/01938924-201513070-00002 ◽

2015 ◽

Vol 13 (7) ◽

pp. 4-12

Author(s):

Jitka Klugarova ◽

Miloslav Klugar ◽

Jiri Gallo ◽

Jana Mareckova ◽

Zuzana Kelnarova

Keyword(s):

Systematic Review ◽

Older Adults ◽

Physical Therapy ◽

Total Hip Replacement ◽

Hip Replacement ◽

Systematic Review Protocol ◽

Post Discharge ◽

Total Hip ◽

Review Protocol

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The association between cement type and the subsequent risk of revision surgery in primary total hip replacement

Acta Orthopaedica ◽

10.1080/17453674.2017.1393224 ◽

2017 ◽

Vol 89 (1) ◽

pp. 40-46 ◽

Cited By ~ 7

Author(s):

Lea Trela-Larsen ◽

Adrian Sayers ◽

Ashley William Blom ◽

Jason Crispin John Webb ◽

Michael Richard Whitehouse

Keyword(s):

Total Hip Replacement ◽

Revision Surgery ◽

Hip Replacement ◽

Cement Type ◽

Total Hip ◽

Subsequent Risk

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Functional outcomes and survival-ship of total hip replacement in patients with Ankylosing Spondylitis: A systematic review

Journal of Arthroscopy and Joint Surgery ◽

10.1016/j.jajs.2017.08.006 ◽

2017 ◽

Vol 4 (3) ◽

pp. 115-120 ◽

Cited By ~ 1

Author(s):

Tarun Goyal ◽

Alexander Schuh ◽

Sujit Tripathy

Keyword(s):

Systematic Review ◽

Ankylosing Spondylitis ◽

Total Hip Replacement ◽

Hip Replacement ◽

Functional Outcomes ◽

Total Hip

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Complications and radiographic findings following cemented total hip replacement

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632994 ◽

2006 ◽

Vol 19 (03) ◽

pp. 172-179 ◽

Cited By ~ 42

Author(s):

R. S. Gilley ◽

F. S. Shofer ◽

A. S. Kapatkin ◽

M. S. Bergh

Keyword(s):

Total Hip Replacement ◽

Revision Surgery ◽

Hip Replacement ◽

Femoral Stem ◽

Short Term ◽

Radiographic Appearance ◽

Radiographic Findings ◽

Total Hip ◽

Technical Errors ◽

Radiographic Changes

SummaryCemented total hip replacement (cTHR) is commonly performed to treat intractable coxofemoral pain in dogs. While owners generally perceive a good outcome after the procedure, the longevity of the implant may be limited by complications such as infection and aseptic loosening. The objective of this retrospective study was to identify the prevalence of complications and radiographic changes following cTHR, and to identify factors that may predispose to a need for revision surgery. Medical records and radiographs from 97 dogs that underwent cTHR were evaluated for signalment, preoperative degree of osteoarthritis, technical errors, intra-operative culture results, and the post-operative radiographic appearance of the implant. The complications occurring in the intra-operative and short-term (<eight week) periods, and the radiographic appearance of the implant in the long-term (>eight week) time period were recorded. Mean (±SD) follow-up time was 1.1 ± 1.6 years (range: 0–7.7 years). Seven dogs had a short-term complication and a revision surgery was performed in eleven dogs. Osseous or cement changes were radiographically detectable in the majority of cTHR. Eccentric positioning of the femoral stem and the presence of radiolucent lines at the femoral cement-bone interface were positively associated with the occurrence of revision surgery. The clinical significance of the periprosthetic radiographic changes is unclear and further investigation is warranted.

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