Undetected Fracture of an Alumina Ceramic on Ceramic Hip Prosthesis

An unusual case of undetected ceramic fracture was discovered by coincidence during total hip arthroplasty revision for sepsis. To our knowledge, this kind of fracture has never been described before. The cup liner was broken in 2 parts, consisting of a large outer annulus and a smaller round central piece that was detached from the superior and posterior part of the cup, creating a hole in the cup. The analysis of the retrievals suggests that the fracture occurred during walking at the contact point between the head and the cup. The ceramic breakage was asymptomatic with no mechanical disorder, suggesting that some ceramic fracture may be tolerated in vivo. However, any evidence of a fractured ceramic component should cause the surgeon to strongly consider revision.