In-Vitro and In-Vivo Ceramic Debris with Ceramic Prosthesis
Ceramic prostheses have had some promising long term results , and modern metal-back alumina cups have shown very good clinical results [2,3,4]. Alumina has excellent tribological properties, a very high Young’s modulus that leads to very good compression strength, but it has poor bending strength: it has no way to deform . This means that ceramic can break without warning. With modern ceramics, under normal physiologic conditions, the fatigue limit is never reached, therefore ceramic head fractures are seldom reported (0.004%10 in one study). On the contrary, ceramic liner fractures are not well recognized and their frequency could be underestimated. Besides, it is difficult to identify those patients at risk, because liner fractures can be related to multiple causes: dislocation, impingement, malpositioning, microseparation [6,7]. When a ceramic fracture involves the liner and is the consequence of repeated micro-trauma, the diagnosis is rarely made early, except when ceramic fragments are visible on X-ray. Moreover, revision surgery decision making after a failed ceramic-on-ceramic prosthesis is troublesome: the ceramic fragments which have spread into the periarticular space are abrasive, and they can lead to early failure of the revision procedure. In a multicenter study on 105 total hip revisions due to ceramic head fracture, Allain et al. reported a second revision rate of 31% (33 hips) at 5 years follow up. The main cause of the repeat revisions was aseptic loosening due to metal and polymethyl methacrylate wear .
KeywordsCeramic Fragment Ceramic Liner Ceramic Bearing Ceramic Fracture Modular Neck
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