The influence of stem taper re-use upon the failure load of ceramic heads

• Stem taper re-use was simulated by repeated in-vitro ceramic head fracture tests.
• Mean fracture strength was constant but standard deviation increased with re-use.
• Visual inspection was not sufficient to predict reduced failure loads.
• Relevant damage could only be revealed by micro-scale surface analysis.
• Taper re-use with ceramic heads without metal sleeve has to be omitted.

Ceramic components are frequently used in total hip replacement due to their good tribological properties. In revision of broken ceramic heads clinical uncertainties arise, whether the taper of the stem can be re-used with a new ceramic head, especially if the stem is well fixed. Ceramic is a brittle material. Even small damage on the male stem taper can lead to stress concentrations causing premature failure of a new ceramic head. As a consequence, manufactures strictly prohibit stem taper re-use for ceramic heads. The aim of this study was to determine the fracture strength of ceramic heads assembled to re-used male stem tapers, which were subjected to prior head fracture. Five 12/14 Ti6Al4V male tapers and 15 Al2O3 ceramic heads (BIOLOX forte®; ∅ 28 mm, L) were used for three consecutive fracture tests. Before and after every fracture test, all components were inspected visually and the surface geometry was analyzed. Mean fracture force (52.5 kN) did not decrease with the number of taper re-uses (p ≥ 0.77) but the range increased significantly from initially 4.1 kN to 31.8 kN for the first and 52.6 kN for the second re-use due to some components failing at very low loads. Visual inspection was not sufficient to predict the reduced failure loads. Ceramic heads should therefore not be put on used male tapers without metal adapter sleeves.