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  • Managing total hip arthroplasty failure due to ceramic liner fracture and cup perforation: revision with bone grafting through direct anterior approach

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Orthopaedics
Managing total hip arthroplasty failure due to ceramic liner fracture and cup perforation: revision with bone grafting through direct anterior approach
  1. Niccolò Stefanini1,
  2. Manuele Morandi Guaitoli1,
  3. Federico Pilla1 and
  4. Cesare Faldini1,2
  1. 11st Orthopaedics and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
  2. 2Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Bologna, Italy
  1. Correspondence to Dr Manuele Morandi Guaitoli; manuele.morandiguaitoli{at}ior.it

Abstract

A man in his mid-70s presented with painful right total hip arthroplasty (THA) developed in over 6 months. Clinically, he exhibited significant deambulatory limitations with limb shortening. Radiographs revealed severe wear of the acetabular liner and superior migration of the prosthetic head, leading to metallosis and osteolysis. CT scan confirmed the prosthetic head’s penetration into the acetabular component. A revision THA was performed using a direct anterior approach (DAA), including extensive debridement and bone grafting. Postoperatively, the patient showed significant improvements in hip function. At the 6-month follow-up, the patient was pain-free, with no signs of dislocation or implant failure and had returned to normal daily activities. This case highlights the importance of early detection and intervention in managing catastrophic failures of ceramic-on-ceramic THA and underscores the need for meticulous surgical technique, particularly in component positioning, to prevent such complications.

  • Prosthesis failure
  • Hip prosthesis implantation
  • Orthopaedics
  • Hip implants

https://doi.org/10.1136/bcr-2024-263855

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    Footnotes

    • X @Niccolo13

    • Contributors All authors contributed equally. CF, FP, NS and MMG performed the surgical procedure. FP and MMG were responsible for data collection and drafting the manuscript, which was subsequently reviewed by CF and NS. NS and MMG monitored the patient during the postoperative period. NS obtained the patient’s informed consent and serves as the guarantor. Overall text and language correction were approved by all the authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.