Background
Ceramic bearings were introduced to reduce wear and increase long-term survivorship of total hip arthroplasties. Ceramic-on-ceramic bearing articulations are harder, scratch resistant and more hydrophilic than other bearing couples, with the benefit of decreased wear and particle load to surrounding tissues.1 So far, long-term follow-up results have been excellent.2,3 Studies comparing ceramic couplings versus metal-on-polyethylene combinations have shown fewer revisions and less osteolysis at ten years.4 Revision of ceramic components, however, is not as straightforward as that of other bearing couples and can be challenging. When revising a ceramic liner, it is important to remove the insert without damage to the inner surface of the cup or fragmentation of the liner. Fragments are a major source of third-body wear to subsequent articulations.5 We describe a simple reproducible method for disengaging the ceramic insert from the acetabular component.
Technique
Circumferential exposure is achieved so the shell and liner are clearly visible. A high frequency drill is held against the outer diameter of the acetabular shell (Fig 1), allowing transmission of the vibrations to the ceramic Morse taper, loosening the taper and allowing the articulation to fail without fragmentation. The loose liner can then be delivered undamaged (Fig 2). Subsequent revision can be performed as required.
Figure 1.
Drill held against outer diameter of acetabular shell
Figure 2.
Removal of ceramic liner in one intact piece
Discussion
Revision of a total hip arthroplasty needs comprehensive knowledge of the characteristics of the articulating materials. This simple yet effective technique, which uses readily available equipment, can be employed when faced with these potentially challenging revisions.
References
- 1.Harris WH. Wear and periprosthetic osteolysis: the problem. Clin Orthop Relat Res 2001; 393: 66–70. [DOI] [PubMed] [Google Scholar]
- 2.Zywiel MG, Sayeed SA, Johnson AJ et al. Survival of hard-on-hard bearings in total hip arthroplasty: a systematic review. Clin Orthop Relat Res 2011; 469: 1,536–1,546. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Capello WN, D’Antonio JA, Feinberg JR et al. Ceramic-on-ceramic total hip arthroplasty: update. J Arthroplasty 2008; 23(7 Suppl): 39–43. [DOI] [PubMed] [Google Scholar]
- 4.D’Antonio JA, Capello WN, Naughton M. Ceramic bearings for total hip arthroplasty have high survivorship at 10 years. Clin Orth Relat Res 2012; 470: 373–381. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Ramachandran M. Basic Orthopaedic Sciences: The Stanmore Guide. London: Hodder Arnold; 2007. [Google Scholar]