The Journal of Bone and Joint Surgery (American). 2008;90:329-336.
doi:10.2106/JBJS.F.01489
© 2008 The Journal of Bone and Joint Surgery, Inc.
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 Adult Hip Reconstruction Test 28: Spring 2008 (publication date May 15, 200...
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Isolated Fracture of the Ceramic Head After Third-Generation Alumina-on-Alumina Total Hip Arthroplasty

Kyung-Hoi Koo, MD1, Yong-Chan Ha, MD2, Woon Hwa Jung, MD3, Sang-Rim Kim, MD4, Jeong Joon Yoo, MD1 and Hee Joong Kim, MD1

1 Department of Orthopaedic Surgery, Seoul National University College of Medicine, 28 Yeongeon–dong, Jongno–gu, Seoul 110-744, South Korea
2 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital 300 Gumi–dong Bundang–gu, Seongnam 463-707, South Korea. E-mail: hychan{at}snubh.org
3 Department of Orthopaedic Surgery, Masan Medical Center, 3 Joongang–dong, Masan 631-716, South Korea
4 Department of Orthopaedic Surgery, Cheju National University Hospital, 154 Samdo2-dong, Jeju 690-716, South Korea

Investigation performed at the Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; the Department of Orthopaedic Surgery, Gyeongsang National University College of Medicine, Chinju, South Korea; the Department of Orthopaedic Surgery, Masan Medical Center, Masan, South Korea; and the Department of Orthopaedic Surgery, Cheju National University College of Medicine, Cheju, South Korea

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: While most reports of component fracture following alumina-on-alumina total hip arthroplasty have involved the acetabular liner, few have involved fracture of the alumina femoral head. In the present multicenter study, we investigated ceramic head fractures in a cohort of patients who underwent third-generation alumina-on-alumina total hip arthroplasty.

Methods: We performed a retrospective study of 312 patients (367 hips) who underwent alumina-on-alumina total hip arthroplasty without cement at four participating centers with the use of a 28-mm BIOLOX forte femoral head and a BIOLOX forte liner from July 2001 to October 2003. Three hundred and five patients (359 hips) were evaluated at a mean of forty-five months postoperatively. Clinical follow-up with use of the Harris hip score and radiographic evaluation were performed at six weeks; at three, six, and twelve months; and every six months thereafter. Retrieved ceramic implants were examined by means of visual inspection.

Results: Five hips (1.4%) in five patients were revised because of a ceramic head fracture during the follow-up period. The ceramic head fractures occurred during normal daily activities at a mean of 22.6 months postoperatively. A short neck had been used in all five hips in which a fracture occurred, compared with 121 (34.2%) of the 354 hips in which a fracture did not occur (p = 0.009). The fracture involved a circular crack along the circumference of the thinnest portion of the head component at the proximal edge of the bore. The fracture also involved multiple vertical cracks extending radially along the longitudinal axis from the circumference of the circular crack line to the lower edge of the head component.

Conclusions: In the present study, the rate of ceramic head fracture associated with one design of a short-neck modular alumina femoral head was 1.4% (five of 359). The extent to which these findings are generalizable to other designs that utilize this type of femoral head is unknown.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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