Outcome after Two Sequential Revision Hip Arthroplasties for CoC Bearing Fracture with 10 Years Follow-up: A Case Report

Introduction: Revisions due to the fracture of ceramic-on-ceramic (CoC) bearing are rare, however when they occur, they represent a major challenge to an orthopedic surgeon for ensuring safe and long-term survival of the replaced bearing. Case Report: We present a case of fractured ceramic liner of total hip prosthesis that underwent revision to a metal-on-polyethylene (MoP) bearing couple, with consequent huge periprosthetic metallosis. Shortly after, the second revision operation followed using the third bearing couple of ceramic-on-polyethylene (CoP). At 10 years follow-up after the operation due to ceramic fracture, the patient is now pain free with full range of motion of the revised hip. Conclusion: Establishment of diagnostic routes and recommended protocols for CoC bearing fracture would allow easier recognition of potential fracture and diminish its consequences for the patients. Keywords: Tribology, Revision Hip Arthroplasty, Ceramic Bearing Fracture.

Production processes and statistical analysis of ceramic liner-hole parameters for sustainability and improved thermal efficiency of clean biomass stoves

In engineering, ceramic liners are used as heat retention, insulation, and wear-resistant components for industrial and domestic applications. However, due to lack of production standards, particularly under small industrial operations, there is variation in liner-hole diameter and inter-hole spacing of liners used in clean biomass stoves. This study assessed the production processes and analysed ceramic liner-hole diameters and inter-hole spacings for standardisation. Standardising liner-hole parameters is a major process towards sustainability and improved efficiency. Methods employed were − material composition, particle size distribution analysis, study of production processes, and 51 liner-hole diameters and 66 inter-holes spacing were randomly sampled and analysed. The results indicated material composition of clay (70%), sand (23%), and sawdust (7%) of various particle sizes. A flow chart diagram of 7 production processes was created for standardisation. At 95% C.I, liner-hole diameter of Ø20.8 ± 2(0.66) mm and inter-hole spacing of 27.5 ± 2(1.06) mm were determined. Mean liner-hole diameter of Ø21.03 mm resulted in a relatively high thermal efficiency, ηT =37%. For practical applications, liner-hole diameter of Ø21 mm and inter-hole spacing of 30 mm are recommended. Standardising the production processes and the liner-hole parameters will contribute to sustainable production and thermal efficiency improvement.

Modular dual-mobility cups using ceramic liners: an original solution for selected indications?

Background: Dual mobility (DM) has been shown to improve stability both in primary and revision total hip arthroplasty (THA) and is increasingly used in patients at high risk of dislocation and in the treatment of THA instability. The introduction of modular liners has helped to overcome some of the limitations of monoblock DM cups. In this context, the use of a ceramic liner would avoid the conventional cobalt-chromium liner in the titanium shell, which can be problematic in some situations. The aim of this paper is to report the outcomes of a consecutive series of patients undergoing revision THA using a modular DM cup with a ceramic liner instead of the conventional metal one, and to clarify the rationale for this currently “off-label” use. Patients and methods: This is a retrospective series of patients who received this new DM bearing in a single institution. Patients were followed up clinically and radiologically at 1 month, 3 months, 6 months and yearly thereafter. Results: 5 patients received the ceramic liner in the study period (2014–2019). The indications were instability or high risk of dislocation in ceramic liner fracture and ARMD with soft tissue damage after MoM THA. The mean age at surgery was 74 (63–82) years, the mean follow-up was 36 (12–72) months. No dislocation occurred, and no adverse events related to the implant were recorded. Conclusions: The use of a ceramic liner in a modular DM cup offers several advantages in selected patients, and the results of our cohort are encouraging. However, caution is needed in introducing this new bearing because knowledge is currently limited. Further studies on a larger number of patients and with longer follow-ups are needed to confirm these findings and before widespread use of the device.

Acetabular liner dissociation: A case report and review of the literature

Dissociation of the polyethylene liner from the acetabular shell is a rare but catastrophic complication of total hip arthroplasty (THA). There have been reports of polyethylene liner dissociation (PLD) as well as ceramic liner dissociation (CLD) in the literature. Amongst the commonly used implants, liner dissociation has been reported with the Pinnacle (DePuy), Harris–Galante (Zimmer) and Trident (Stryker) acetabular components. To the best of our knowledge, this is the first case report of PLD in an R3 (Smith & Nephew) acetabular component. This case report highlights the implant choice for treatment of the liner dissociation and the role of constrained implants in such cases.