Fracture Of Ceramic Femoral Head Research Articles

Long Term Survivorship of a Severely Notched Femoral Stem after Replacing the Fractured Ceramic head with a Cobalt-Chromium Head.

Background:Although ceramic head fracture occurs infrequently today, in the event of a fracture, the resulting revision surgery can prove very challenging, since the ceramic particles lodge into the surrounding soft tissue and can cause rapid implant failureCase Presentation:A case of long term survivorship of a severed notched femoral stem after replacing the fractured femoral head with a cobalt-chromium one is reported in a 40-year old woman with hip dysplasia who underwent an uncomplicated total hip arthroplasty. The incident of ceramic femoral head fracture occurred 14 months postoperatively without reporting any significant trauma. Intraoperative findings at revision were a multifragmented femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt-chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At the 13th year follow up examination, the patient had no pain, used no walking aids, and had normal activity with no signs of wearing or loosening in the plain x-rays.Conclusion:Despite current recommendations of using ceramic femoral heads in cases of fracture or to revise the severely damaged stems we were able to provide a long term survivorship up to 13 years postoperatively of a cobalt-chromium femoral head applied to a severe damaged stem.

Ceramic Femoral Head Fracture and Severe Wear of the Cone: A Case Report and Review of the Literature

A case of a fractured ceramic femoral head without subsequent trauma, 8 years after a primary total hip arthroplasty, in a 36-year-old man with Osteonecrosis of femoral head (ONFH) is reported. Intraoperative findings were multifragment femoral head without damage of the ceramic insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After the removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint and a ceramic femoral head was placed to the existing notched taper of the firmly incorporated stem, the ceramic inlay was kept. At 3-month follow-up examination, the patient had no pain, used no walking aids and had normal activity.

Atraumatic Fracture of a BIOLOX Delta Ceramic Femoral Head Articulating with a Polyethylene Liner: A Case Report.

We describe the case of a forty-one-year-old man who underwent total hip arthroplasty with a 32-mm BIOLOX delta ceramic head articulating with a polyethylene liner. The patient did not suffer any trauma postoperatively, and his only symptom was of a "clicking" noise from the operatively treated hip. At his six-week postoperative review, fracture of the femoral head was diagnosed. Fracture of a ceramic femoral head is a rare but catastrophic complication. This case report highlights the importance of vigilance on the part of the surgeon when reviewing patients after hip arthroplasty with ceramic-on-polyethylene bearing couples, even with limited symptoms associated with the hip and no reported trauma.

Fracture of a BIOLOX Delta Ceramic Femoral Head Articulating Against a Polyethylene Liner: A Case Report.

A forty-five-year-old woman underwent primary total hip arthroplasty with a 36-mm BIOLOX delta ceramic femoral head articulating against a polyethylene liner. She presented with hip pain at eighteen months postoperatively, two months after being in a bicycle accident; fracture of the femoral head was diagnosed. The possibility of a ceramic femoral head fracture should be decreased with use of the latest generation of ceramic material, a ceramic-on-polyethylene articulation rather than a ceramic-on-ceramic articulation, and a larger head size, all of which applied to this case. Taper-trunnion compatibility and correct intraoperative handling of the components are also essential.

Initial Misdiagnosis of a Traumatic Ceramic Femoral Head Fracture

A destructive ceramic head fracture was diagnosed 1 year after a serious motorcycle accident in a patient who had undergone primary THA 7 years earlier. Introduction In the 1970s, Boutin implemented ceramic in modern total hip arthroplasty (THA). Although initial fracture rates of 13.4 % for ceramic heads were described before the 1990s, the inferior rate of wear and friction when compared with metallic heads and the optimized tribology wre promising in THA [1-3]. Gradual improvements in processing of the material led to a significant reduction of the fracture rate to below 0.1 % [3]. Thus, alumina ceramic heads have currently become the standard material in THA with ceramic bearing surfaces.Nevertheless, multiple case reports have been published describing ceramic head fractures [4-11]. The causes of fractures are diverse and vary from traumatic events [5,9,12,13] to impingement between the neck and the liner rim [7]. Spontaneous fractures without any history of trauma have also been described [4,6,8,10,11]. However, only two reports describing delayed fractures of ceramic heads were found [12,13].In this report, we present a 24-year old patient who underwent primary THA at our institution and was a victim of high-energy trauma 7 years later. Initial radiographs were misinterpreted in a non-designated total joint clinic at the time of primary admission (after the accident). A destructive ceramic head fracture was diagnosed more than 1 year after initial trauma at our institution, with major destruction of the ceramic head and the remaining THA.This was followed by an extensive revision. Based on this experience, the general question of adequate radiographic diagnosis after trauma to a THA, especially one with partial or full ceramic bearing surfaces, will be further discussed in this report.

ブロック状骨移植併用したAlumina on Alumina型人工股関節置換術後に骨頭の破損をきたした1例

ブロック状骨移植併用したAlumina on Alumina型人工股関節置換術後に骨頭の破損をきたした1例

Fracturing of Revision of a Cobalt-chrome Femoral Head after Fracturing of a Ceramic Femoral Head, with Diffuse Metallosis. Case Report

We presente a case of a fracture of a cobalt-chrome femoral head after revision of a hip total prosthesis with ceramic femoral head fracture. During surgery we found the cobalt- chrome femoral head fracture, wear of the polyethylene and massive metallosis in muscular and cartilaginous tissue. Both femoral stem and acetabular cup were stable and without apparent wearing. After surgical debridement, we promoted the substitution of the femoral head and the acetabular polyethylene by similar ones. After 12 months of follow- up, the patient has no pain complaints, function limit or systemic signs associated with malign metallosis.

Fratura de cabeça femoral de crómio-cobalto de revisão após fratura de cabeça femoral de cerâmica, com metalose difusa. Caso clínico

We presente a case of a fracture of a coblat-chrome femoral head after revision of a hip total prosthesis with ceramic femoral head fracture. During surgery we found the cobaltchrome femoral head fracture, wear of the polyethylene and massive metallosis in muscular and cartilaginous tissue. Both femoral stem and acetabular cup were stable and without apparent wearing. After surgical debridement, we promoted the substitution of the femoral head and the acetabular polyethylene by similar ones. After 12 months of followup, the patient has no pain complaints, function limit or systemic signs associated with malign metallosis.

What would you do?

A moderator and panel of five experts led an interactive session in discussing five challenging and interesting patient case presentations involving surgery of the hip. The hip pathologies reviewed included failed open reduction internal fixation of subcapital femoral neck fracture, bilateral hip disease, evaluation of pain after metal-on-metal hip arthroplasty, avascular necrosis, aseptic loosening secondary to osteolysis and polyethylene wear, and management of ceramic femoral head fracture.

Traumatic Ceramic Femoral Head Fracture: An Initial Misdiagnosis

Background and Purpose:Ceramic heads are widely used in modern total hip arthroplasty (THA). Although a rare complication, fractures of ceramic heads are described in the literature, evoking uncertainties regarding the in vivo stability of this material, especially when impaction of a fractured ceramic head can lead to disastrous results.Methods:In this case report, we present a fracture of a ceramic head after trauma. A misinterpretation of the initial radiographs led to severe fragmentation of the ceramic head two weeks after the incident, later resulting in complete destruction of the arthroplasty.Results and Interpretation:Remarkably, radiographs obtained more than one year after the trauma led to this delayed diagnosis. A single radiographic evaluation, especially in patients with persistent pain after major trauma, with a ceramic head in a THA, seems to be insufficient

인공고관절 치환술 후 세라믹 대퇴골두에서 발생하는 응력분포 예측

Ceramic femoral heads are now widely used in Total Hip Replacement (THR). Due to their high biocompatibility and low ductility, ceramic femoral heads are considered to be suitable for young and active patients. However, as in testing the mechanical stability of the femoral head, the conventional proof test (standard ISO 7206-10) has its limit of showing axisymmetric stress distribution on the contact surface, while non-uniformed stress distribution is expected after THR. Since non-uniformed stress distribution can result in the increased probability of ceramic femoral head fracture, it is considerable to evaluate the stress distribution in vivo-like conditions. Therefore, this study simulated the ceramic femoral heads under in vivo-like conditions using finite element method. The maximum stress decreased when increasing the size of the femoral head and stress distribution was concentrated on superior contact surface of the taper region.

What Would You Do? Challenges in Hip Surgery

A moderator and panel of five experts led an interactive session in discussing five challenging and interesting patient case presentations involving surgery of the hip. The hip pathologies reviewed included failed open reduction internal fixation of subcapital femoral neck fracture, bilateral hip disease, evaluation of pain after metal-on-metal hip arthroplasty, avascular necrosis, aseptic loosening secondary to osteolysis and polyethylene wear, and management of ceramic femoral head fracture.

Alumina Femoral Head Fracture in Uncemented Total Hip Arthroplasty With a Ceramic Sandwich Cup

In total hip arthroplasty, insertion of a UHMWPE-coated ceramic sandwich liner dramatically reduces any risk related to the stiffness of the ceramic-ceramic coupling. We present a case of an alumina ceramic head fracture with a ceramic sandwich cup. The fracture occurred 16 months after the initial operation, without trauma. Impingement between the neck and posteroinferior portion of the liner rim had occurred. This was related to the traditional cross-legged sitting position of Koreans, which caused impingement between the neck and liner rim. Consequently, the taper became loose, and the resulting force bent the taper and fractured the head. We examined a peculiar case of ceramic femoral head fracture after implantation of an uncemented total hip arthroplasty with a ceramic sandwich cup and investigated the underlying cause.

Ceramic femoral head fracture with massive metallosis and severe wear of the cone: a case report and review of the literature

A case of a fractured ceramic femoral head without subsequent trauma, 14 months after a primary total hip arthroplasty, in a 40-year-old woman with hip dysplasia is reported. Intraoperative findings were multifragment femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After the removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt–chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At 22-month follow-up examination, the patient had no pain, used no walking aids and had normal activity.

人工股関節全置換術後に発生したセラミックボール破損の一例

人工股関節全置換術後に発生したセラミックボール破損の一例

Catastrophic failure of the acetabular component in a ceramic-polyethylene bearing total hip arthroplasty

Recent research in total hip arthroplasty has focused on attempts to decrease wear at the femoral head-acetabulum articulation, to limit the production of debris that is believed to lead to osteolysis and prosthetic loosening. The use of ceramic-on-polyethylene bearing surfaces has been reported to produce lower wear rates and therefore may increase the life expectancy of the joint arthroplasty. Problems with this bearing have been reported to be due to ceramic femoral head fracture. Reported here are 2 cases of catastrophic failure of total hip arthroplasties, involving a ceramic femoral head, caused by failure of the polyethylene acetabular liner, with subsequent penetration of the femoral head through the acetabular shell.

Proceedings of the British Medical Ultrasound Society 26th annual meeting. Scarborough, 14-16 December 1994. Abstracts.

AIM: To assess the role of ultrasound in management of patients with symptomatic total hip replacements (THR). MATERIALS AND METHOD: 26 patients with symptoms following THR (2–11 years post-surgery) were examined sonographically using a 5–6 MHz curvilinear transducer (Diasonics Prisma) over a 12 month period. Any fluid collection was aspirated for bacteriology and any soft tissue masses were core biopsied for histological assessment. Ultrasound appearances as well as transducer compression tenderness were noted. RESULTS: Ultrasound diagnoses included: wear debris granulomata, 14 (definite, 5; probable, 6; possible, 3); prosthetic infection, 3 (2 with sequestra at level of femoral component tip); trochanteric wire problems, 10 (granulation tissue formation, 3; bursa formation, 3; infection, 2; haematoma, 1; compression tenderness without focal ultrasound abnormality, 1); femoral shaft fracture, 1; greater trochanter fracture, 1; acetabular screw granulation tissue, 1; heterotopic ossification, 3; ?ceramic femoral head fracture, 1; normal study (but possible early loosening on X-ray), 3. CONCLUSION: Ultrasound is an extremely useful method of initial evaluation of symptomatic total hip replacements.