What an Orthopedic Surgeon Should Know: Selection of a Bearing Couple in Case of Revision After a Fractured Ceramic Component

Revision surgery for fractured ceramic components in total hip arthroplasty (THA) potentially leaves small ceramic fragments in the joint capsule, and the fragments might become embedded in polyethylene (PE) acetabular liners. The purpose of this study was to determine the wear behavior of metal femoral ball heads and ceramic femoral ball heads tested with highly cross-linked and conventional polyethylene liners in the presence of ceramic debris. A worst-case scenario, assuming embedding of ceramic fragments in the PE liner, contamination of the test environment with third-body ceramic debris and continuous subluxation, was simulated in vitro. High wear rates were found for metal femoral ball heads, being 1,010 times higher when compared to ceramic femoral ball heads tested with XPE liners and 560 times higher when compared to ceramic femoral ball heads tested with PE liners. The test results indicate the use of ceramic femoral ball heads for revision surgery in the presence of ceramic fragments.