Question
A 50 year old man with bilateral total hip arthroplasties felt a crack and sudden pain in his left hip while getting out of a car.
- Describe the radiograph.
- What are the risk factors for ceramic component fracture?
- How would you revise this hip?
Answer
Radiograph
- Bilateral total hip arthroplasties
- Fragmented femoral head component on the left
- Ceramic head fracture
Risk factors
- Older alumina ceramics, delta ceramics (zirconia toughened) are stronger
- Small heads (28 mm) and short neck heads
- Impaction onto a damaged or contaminated trunnion
- Mismatched taper
- Cup malposition with edge loading
- Trauma
Revision
- Early revision before further damage
- Complete synovectomy to remove all ceramic fragments
- Remove the ceramic liner as well
- Inspect the trunnion, revise the stem if damaged
- Ceramic on ceramic or ceramic on polyethylene with a new ceramic head and titanium sleeve
- Never use a metal head, ceramic third body particles cause catastrophic metal wear and cobalt toxicity
- Cobalt toxicity can cause cardiomyopathy, blindness and deafness
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.