A late dissociation of the ceramic component of a sandwich liner cup in a total hip arthroplasty
—Case report and review of the literature

Pieter-Jan De Roo, Franky Steenbrugge, Martijn Raaijmaakers

Department of Orthopaedic Surgery & Traumatology, Aalst, Belgium.

DOI: 10.4236/crcm.2013.22037                

Abstract

We present a case of a 71-year-old woman with unexplained instability of her total hip arthroplasty 12 years after implantation due to loosening of the ceramic component of a sandwich ceramic in polyethylene liner. She experienced in total 2 dislocations in 6 months. These events occurred without fracture of the ceramic liner. Sandwich ceramic liners were introduced with the idea of combining the benefits of ceramic and polyethylene bearings in total hip arthroplasty in order to reduce wear and to allow a ceramic on ceramic bearing to be used in a cup designed for polyethylene inserts only. Although some reports showed promising early results, case reports and later on retrospective analysis showed high fracture rates of the ceramic liner component. We believe that loosening of the ceramic component may precede fracture of the liner and that a ceramic on ceramic configuration is preferable.

Keywords

Total Hip Arthroplasty; Sandwich Cup; Complication; Hip Instability; Cup Revision

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Rubash, H.E., Sinha, R.K., Shanbhag, A.S. and Kim, S.Y. (1998) Pathogenesis of bone loss after total hip arthroplasty. Orthopedic Clinics of North America, 292, 173-186.
[2]	Ravasi, F. and Sansone, V. (2002) Five-year follow-up with a ceramic sandwich cup in total hip replacement. Archives of Orthopaedic and Trauma Surgery, 122, 350-353.
[3]	Boutin, P. (1972) Total arthroplasty of the hip by fritted aluminum prosthesis. Experiment study and 1st clinical applications. Revue de Chirurgie Orthopedique et Reparatrice de l’Appareil Moteur, 583, 229-246.
[4]	Akagi, M., Nonaka, T., Nishisaka, F., Mori, S., Fukuda, K. and Hamanishi, C. (2004) Late dissociation of an alumina-on-alumina bearing modular acetabular component. Journal of Arthroplasty, 195, 647-651. doi:10.1016/j.arth.2004.02.027
[5]	Lopes, R., Philippeau, J.M., Passuti, N. and Gouin, F. (2012) High rate of ceramic sandwich liner fracture. Clinical Orthopaedics and Related Research, 4706, 1705-1710. doi:10.1007/s11999-012-2279-6
[6]	Kirchner, J., Bader, R., Schroeder, B. and Mittelmeier, W. (2009) Extremely high fracture rate of a modular acetabular component with a sandwich polyethylene ceramic insertion for THA: A preliminary report. Archives of Orthopaedic and Trauma Surgery, 129, 1145-1150. doi:10.1007/s00402-008-0662-2
[7]	Szymanski, C., Guériot, S., Boniface, O., Deladerrière, J.Y., Luneau, S. and Maynou, C. (2011) Sandwich type ceramic liner fracture with the Atlas IIITM socket: A study of 144 primary total hip replacements at a mean 74 months’ follow-up. Orthopaedics & Traumatology: Surgery & Research, 975, 494-500.
[8]	Viste, A., Chouteau, J., Desmarchelier, R. and Fessy, M.H. (2012) Fractures of a sandwich ceramic liner a ten year follow-up. International Orthopaedics, 36, 955-960. doi:10.1007/s00264-011-1375-7
[9]	Zywiel, M.G., Sayeed, S.A., Johnson, A.J., Schmalzried, T.P., Mont, M.A. (2011) Survival of hard-on-hard bearings in total hip arthroplasty: A systematic review. Clinical Orthopaedics and Related Research, 469, 1535-1546. doi:10.1007/s11999-010-1658-0
[10]	Hasegawa, M., Sudo, A., Hirata, H. and Uchida, H. (2003) Ceramic acetabular liner fracture in total hip arthroplasty with a ceramic sandwich cup. Journal of Arthroplasty, 185, 658-661. doi:10.1016/S0883-5403(03)00193-1
[11]	Park, Y.S., Park, S.J. and Lim, S.J. (2010) Ten-year results after cementless THA with a sandwich-type ceramic bearing. Orthopaedics, 3311, 796.
[12]	Popescu, D., Gallart, X., Garcia, S., Bori, G., Tomas, X. and Riba, J. (2008) Fracture of a ceramic liner in a total hip arthroplasty with a sandwich cup. Archives of Orthopaedic and Trauma Surgery, 128, 783-785. doi:10.1007/s00402-007-0536-z
[13]	Poggie, R.A., Turgeon, T.R. and Coutts, R.D. (2007) Failure analysis of a ceramic bearing acetabular component. Journal of Bone & Joint Surgery, 89, 367-375. doi:10.2106/JBJS.F.00148