Ceramic Liner Fracture and Impingement in Total Hip Arthroplasty

HSS Journal Online First Article

Amy Steinhoff, MD

Department of Orthopedics, Kaiser Permanente, San Diego, CA

Victor Hakim MD

Hakim Joint Replacement, Plano, TX

Richard H. Walker, MD

Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA

Clifford W. Colwell, Jr. MD

Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA

Steven N. Copp, MD

Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA
Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA


Ceramic-on-ceramic bearing surfaces were developed to provide an alternate to metal-on-polyethylene to decrease wear-induced osteolysis in total hip arthroplasty patients. In an effort to decrease the risk of ceramic acetabular component fracture or damage during implantation, a raised metal rim was added.

How many fractures or impingements have occurred in our population of patients with ceramic liners with raised rims?

With IRB-approved consent, a case series was reviewed from a single center registry and 4 of 169 patients were identified who had revision hip surgery with the ceramic liner with a raised metal rim: one for ceramic liner fracture and three for metallosis, pain, and squeaking. Implant alignment and operative findings were reviewed.

One ceramic liner fracture and three cases of metallosis from impingement of the femoral neck on the posterior elevated metal rim of the acetabular liner were observed at revision. The femoral neck in each patient had a divot that corresponded to a divot in the posterosuperior liner rim. Three of the four patients had audible squeaking or clicking prior to revision. A total of 3% of patients in this series had clinically significant impingement with this implant type.

Acoustic phenomenon in a ceramic on ceramic bearing surface should be investigated with a cross-table lateral radiograph to evaluate component position. If symptomatic impingement is demonstrated, revision should be considered to avoid failure from metallosis or fracture.

Level of Evidence: Level IV - Case series (no, or historical, control group).

This article appears in the HSS Journal: Volume 11, Issue 1.
View the full HSS Journal article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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