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Options When a Ceramic Hip Replacement Breaks

Posted on: 11/30/1999
The implants that are used to replace the hip joint are made of ceramic, metal, or plastic. The use of ceramic for the femoral head (the round ball at the top of the thighbone) started about 30 years ago. Ceramic is very smooth but sometimes creates problems when used as a hip joint replacement. Ceramic is weak and brittle compared to metal. The early ceramic implants were prone to fracture. With better materials, there are fewer fractures now--only one in 10,000, compared to one in 2,000 early on.

Many people have ceramic hip implants. A group of doctors in France looked at the results of treatment after fracture of the femoral head portion of the implant. They compared the success and problems using different treatment methods. The authors of this study were able to find three factors affecting results of treatment when repairing a fracture in the ceramic femoral head.

The material used to replace the femoral head is important. A new ceramic head can be used. One made of cobalt-chromium is also acceptable. Stainless steel is not advised for the femoral head. Too many patients end up with uneven wear and tear with this material.

Replacing the cup (socket) at the same time the head is revised is also important. The authors say that the cup should be removed and replaced even if it looks normal. Tiny ceramic particles may be embedded in the cup.

Finally, complete removal of the synovium is advised. The synovium is a thin layer of tissue lining the joint. Removing this tissue removes as much of the ceramic debris as possible.

The authors conclude by saying that although fracture of a ceramic head is rare now, the results can be disastrous for the patient. Treatment to revise the fractured implant isn't always successful. Doctors should follow the three suggestions during revision for a good result.

Jerome Allain, MD, et al. Revision Total Hip Arthroplasty Performed after Fracture of a Ceramic Femoral Head. In The Journal of Bone and Joint Surgery. May 2003. Vol. 85-A. No. 5. Pp. 825-830.

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