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      Delayed diagnosis of catastrophic ceramic liner failure with resultant pelvic discontinuity and massive metallosis

      case-report

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          Abstract

          With newer-generation ceramic components used in total hip arthroplasty, component fracture is a rare complication. However rare, when ceramic component fracture does occur, prompt identification and revision is necessary as delay can lead to dramatic failure with resultant metallosis as the extremely hard ceramic debris abrades remaining components. We present a case of a 70-year-old woman with ceramic liner fracture and an estimated 10-year delay in intervention with failure resulting in pelvic discontinuity and massive metallosis with associated cutaneous manifestation. She was treated with a complex revision and reconstruction and is 2 years postrevision without major complication.

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          Most cited references33

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          The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty.

          Early reports on modern ceramic-on-ceramic total hip replacements have demonstrated excellent clinical and radiographic results with few cases of catastrophic failure, which, in the case of earlier designs, often had been caused by implant fracture. Several reports, however, have noted the presence of audible squeaking. The purpose of the present study was to determine the incidence of squeaking in association with the use of this bearing couple.
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            Ceramic-on-ceramic total hip arthroplasty: update.

            This prospective, randomized, multicenter study of alumina ceramic-on-alumina ceramic bearing couples includes 452 patients (475 hips). Their average age was 53 years with approximately two thirds men and 82% with osteoarthritis. At an average 8-year follow-up, clinical results were excellent and cortical erosions significantly less than in the conventional polyethylene-on-metal bearing group. Nine hips have undergone revision of one or both components for any reason. Of the 380 ceramic liners, 2 (0.5%) have fractured requiring reoperation, and 3 (0.8%) ceramic patients reported a transient squeaking sound, one of which had a head and liner change due to groin pain secondary to psoas tendinitis at 5 years. With no revisions for aseptic loosening and minimal cortical erosions, alumina-ceramic bearing couples are performing in a manner superior to the polyethylene-on-metal bearing in this young, active patient population.
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              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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                Author and article information

                Contributors
                Journal
                Arthroplast Today
                Arthroplast Today
                Arthroplasty Today
                Elsevier
                2352-3441
                01 December 2016
                June 2017
                01 December 2016
                : 3
                : 2
                : 77-82
                Affiliations
                [1]Department of Orthopedics and Rehabilitation, The Oregon Health Science University, Portland, OR, USA
                Author notes
                []Corresponding author. 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239, USA. Tel.: +1 303 725 1916.3181 S.W. Sam Jackson Park Rd.PortlandOR97239USA BenWinston24@ 123456yahoo.com
                Article
                S2352-3441(16)30069-3
                10.1016/j.artd.2016.11.002
                5485230
                28695178
                2d78c218-7aa9-45e6-b8f8-d15b1dff41d2
                © 2016 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 7 September 2016
                : 4 November 2016
                : 9 November 2016
                Categories
                Case Report

                ceramic on ceramic,total hip arthroplasty,revision arthroplasty,metallosis,ceramic liner fracture,cutaneous manifestation of metallosis

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