Fourth generation head fracture in ceramic-on-polyethylene bearing after hip revision surgery: a case report

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Roberto Valentini
Andrea Vacchiano
Andrea Sandri
Dario Regis
Carlo Dall’Oca
Bruno Magnan


total hip arthroplasty, revision hip surgery, ceramic-on-polyethylene, BIOLOX delta ceramic head, fracture


Fourth generation ceramic bearings (BIOLOX delta, CeramTec AG; Phlochingen, Germany) were
developed to reduce wear debris and improve fracture resistance. A case of a fourth generation head fracture
in ceramic-on-polyethylene (COP) coupling after hip revision surgery is reported. A 58-year-old man
was admitted to our department for increasing hip pain following a direct trauma which occurred during
skiing activity 4 months before. Six years earlier, he had undergone a right cementless revision surgery with a
36-mm BIOLOX delta femoral head on polyethylene liner for metallosis and foreign body reaction after primary
total hip replacement for hip osteoarthritis. At admission, radiological evaluation revealed a fracture of
ceramic femoral head requiring a new revision surgery. Extensive synovectomy, lavage and capsulectomy were
performed. Both acetabular cup and femoral stem were well fixed with no damage of trunnion, and therefore
they were retained. A 36-mm internal diameter polyethylene acetabular liner was inserted along a 36-mm
BIOLOX delta head with a BioBall adapter XL. The postoperative course was uncomplicated. At 1-year
follow-up, the patient had a complete functional recovery. To our knowledge, BIOLOX delta ceramic femoral
head fracture after COP hip revision surgery has not been previously reported.


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