arthroplasty
Ceramic Head Fracture in THA
advanced
6 min
22 marks
5 questions
Clinical Scenario
A 52-year-old man presents with sudden onset severe hip pain after feeling a "crack" while rising from a chair. He had a ceramic-on-ceramic THA 8 years ago for avascular necrosis. He reports immediate inability to weight bear and describes a grinding sensation with any attempted movement. On examination, the hip is held in flexion and any passive motion elicits severe pain with audible crepitus.
AP radiograph showing THA with fragmented ceramic femoral head. Multiple ceramic fragments visible within the joint. Cup appears well-fixed. Significant periarticular debris pattern.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
What is the likely diagnosis and what are the risk factors for this complication?
Question 2 (4 marks)
What imaging would you request and what would you look for?
Question 3 (5 marks)
What are the surgical management principles for ceramic head fracture?
Question 4 (4 marks)
What complications can occur if ceramic fragments are retained?
Question 5 (5 marks)
What would you counsel the patient regarding bearing surface selection for revision and expected outcomes?
Exam Day Cheat Sheet
Must Mention
- •Ceramic fracture is a SURGICAL EMERGENCY
- •BIOLOX delta fracture risk: 0.01-0.02% (lower than 3rd gen)
- •MUST remove ALL ceramic fragments - third-body wear devastating
- •NEVER metal head if ceramic debris may remain
- •Taper assessment: damaged taper = stem revision or titanium sleeve
- •Ceramic-on-ceramic preferred for revision
Common Pitfalls
- •Metal head with retained ceramic
- •Incomplete debridement
- •Not checking taper damage
- •Delayed surgery
- •Inadequate exposure (no ETO)
- •Not using imaging to confirm debris removal