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Ceramic-on-polyethylene: a viable revision THA option after ceramic fracture?

Ceramic bearing breakage is an extremely rare yet challenging complication in total hip arthroplasty (THA). While ceramic-on-ceramic (CoC) remains the most commonly used revision bearing, some surgeons choose ceramic-on-polyethylene (CoP) for its greater surgical flexibility – particularly in complex cases. Yet the approach raises concerns about accelerated polyethylene wear due to residual ceramic debris.

This dilemma is the focus of a new clinical and in vitro study by Dr. Jonathan Barrow and team (John Charnley Trust, University of Leeds), who examined whether ceramic-on-polyethylene (CoP) bearings are a viable alternative following such events.

Method 1: Retrospective Radiological Review  

  • 12 patients revised for ceramic failure (2016–2019) -> all revised to BIOLOX®𝑑𝑒𝑙𝑡𝑎 ceramic heads with XLPE liners
  • Wear measured on calibrated AP radiographs using TraumaCadWear was calculated from immediate post-op to latest follow-up images
  • Follow-up wear assessed from immediate post-op to latest imaging
  • Excellent intra- and inter-rater reliability (ICC=0,99)

Method 2: In Vitro Wear Simulation

  • Simulated ceramic particle debris generated by fracturing a ceramic liner against a CoCr head
  • Ceramic fragments (<1 mm) embedded in CoP, CoC, and MoP bearings
  • Each construct tested under identical conditions in a hip simulator (7200 cycles, 3 kN peak load)
  • Surface roughness of the heads, measured pre- and post-test  

Key Findings

  • Retrospective radiological review
    • Average linear wear: 0.08 mm/year – comparable to primary CoP THA
    • Average follow-up: 3.8 years
    • N️o evidence of radiological loosening or osteolysis
  • 𝐼𝑛 𝑣𝑖𝑡𝑟𝑜 results:
    • MoP bearings = significant increase in femoral head surface roughness, indicating substantial damage
    • CoP + CoC bearings = minimal increases in surface roughness, supporting the claim that ceramic particles embedded in polyethylene do not excessively damage the BIOLOX®delta ceramic head

Takeaway

This combined clinical and lab approach strengthens the study’s conclusion that CoP bearings offer a mechanically and biologically stable solution, especially in complex cases of full component revision or optimal alignment.

MoP, on the other hand, showed a significant increase in roughness in the in vitro third-body wear study, which could lead to a high risk of catastrophic wear in vivo with critical consequences for the patient. Therefore, this study does not recommend the use of MoP.

Please check for regulatory approval in your country.

References: 
Gunn C, Thakker V, Williams S, Board TN, Wynn-Jones H, Barrow J. Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture? Bone Jt Open. 2025;6(6):700-706. doi: 10.1302/2633-1462.66.BJO-2025-0030.R1.

𝑇ℎ𝑖𝑠 𝑝𝑜𝑠𝑡 𝑤𝑎𝑠 𝑐𝑟𝑒𝑎𝑡𝑒𝑑 𝑤𝑖𝑡ℎ 𝑡ℎ𝑒 𝑠𝑢𝑝𝑝𝑜𝑟𝑡 𝑜𝑓 𝐴𝐼.

 

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