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Rare but Manageable: 36 cases prove ceramic-on-ceramic to be a viable option after ceramic fracture

Ceramic component fracture is a very rare complication in total hip arthroplasty (THA). But when it does happen, the choice of revision strategy matters.

Following the insights from Dr. Jonathan Barrow et al. on using ceramic-on-polyethylene (CoP) in revision total hip arthroplasty, new long-term data from Dr. Francesco Castagnini and colleagues at the Rizzoli Institute present an even more ceramic-centric approach: ceramic-on-ceramic (CoC) revision.

Study background

  • Among 1,909 revision THAs performed at Rizzoli between 2004 and 2019, 39 involved ceramic component failure (about 2 in every 100 revision cases).
  • These were revision surgeries, not all hip replacements. In the broader context, ceramic fractures are rare, typically fewer than 10 in 100,000 primary THAs.
  • After applying strict inclusion criteria (CoC revision, ≥2 years follow-up, complete records), 36 patients were included, with a mean follow-up of 12.2 years.

Revision strategy and bearing selection

  • 83.3% of failures involved BIOLOX®forte (22 liners, 12 heads); 16.7% involved BIOLOX®delta (1 head, 5 liners)
  • Revision strategy included
    • 100% head revision
    • 91.7% liner exchange
    • 50% cup revision
  • All revised to CoC bearings with systematic synovectomy
  • BIOLOX®delta heads used (or forte where needed) + BIOLOX®OPTION or BIOBALL® sleeves for taper damage
  • 72.2% of cases received delta-on-delta bearings

Clinical outcomes

  • 5-year survival: 96.6%
  • 10-year survival: 83.7%
  • No tribological failures or osteolysis
  • Mean Harris Hip Score: 85.1
  • 58.3% of patients rated their outcome as excellent
  • Noise reported in 16.7%, but without clinical consequence

Takeaway

Ceramic fracture is extremely rare, and this study shows that when it does occur, it can be managed effectively with a ceramic-on-ceramic articulation.

Castagnini et al. confirm that ceramic-on-ceramic revision – when performed with attention to component selection, taper condition, and intraoperative debridement – can achieve strong long-term outcomes after ceramic fracture.

The results complement Barrow’s findings on CoP revision and support the view that both CoP and CoC are viable options when tailored to the clinical scenario.

Please check for regulatory approval in your country.

References:
Di Carlo G, Gorgone M, Salinari M, Minerba A, Castagnini F, Traina F. Revision hip arthroplasty after fractured ceramic bearings using ceramic-on-ceramic surfaces: long-term clinical and radiological outcomes of 36 cases. J Arthroplasty. 2025:S0883-5403(25)00825-3. doi:10.1016/j.arth.2025.06.074.
 

This post was created with the support of AI.
 

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