Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture?
Aims: Ceramic bearing fracture is a rare complication following implantation using modern ceramic bearing materials. The ideal revision bearing option in such cases is debated. We aimed to investigate the safety of a hard on soft bearing following ceramic fracture in total hip arthroplasty. Methods...
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| Format: | Article |
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The British Editorial Society of Bone & Joint Surgery
2025-06-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.66.BJO-2025-0030.R1 |
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| author | Christopher Gunn Vivek Thakker Sophie Williams Timothy N Board Henry Wynn-Jones Jonathan Barrow |
| author_facet | Christopher Gunn Vivek Thakker Sophie Williams Timothy N Board Henry Wynn-Jones Jonathan Barrow |
| author_sort | Christopher Gunn |
| collection | DOAJ |
| description | Aims: Ceramic bearing fracture is a rare complication following implantation using modern ceramic bearing materials. The ideal revision bearing option in such cases is debated. We aimed to investigate the safety of a hard on soft bearing following ceramic fracture in total hip arthroplasty. Methods: Data on all patients undergoing revision following ceramic fracture between January 2016 and January 2019 were collected retrospectively. Templating software was used to determine linear wear between the first post-revision radiograph and latest available follow-up. Univariate analysis was used to examine patient demographics and the wear rates of the polyethylene components. The intra- and inter-rater reliability of wear measurements was calculated. Additionally, in vitro testing was undertaken to assess the effects on bearing surfaces of residual ceramic particles. Results: A total of 12 patients underwent revision for ceramic fracture in the study period. The mean age at revision was 62 years (54 to 72). There were six liner and six head fractures revised to delta ceramic heads and cross-linked polyethylene acetabular components. At mean follow-up of 3.8 years (0.5 to 6.1), median 4.4 years (IQR 2.0 to 5.1), linear wear rate was calculated at 0.08 mm/year (SD 0.06). Both intra- and inter-rater reliability was excellent with intraclass correlation coefficient (ICC) scores of 0.99 at all timepoints. In vitro testing showed an increase in head roughness in metal on polyethylene bearings after ceramic particles were embedded, but no increase in ceramic on polyethylene (CoP) or ceramic on ceramic bearings. Conclusion: Revision to CoP bearings following ceramic fracture does not cause early catastrophic wear at early follow-up, aligning with the in vitro study observations. It appears safe to use this hard on soft bearing combination, given that wear rates are comparable to what is expected in a primary hip arthroplasty setting. Longer follow-up is required to establish if this trend persists. Cite this article: Bone Jt Open 2025;6(6):700–706. |
| format | Article |
| id | doaj-art-d27af185a3dd47d48aa2deeba9879dad |
| institution | Kabale University |
| issn | 2633-1462 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj-art-d27af185a3dd47d48aa2deeba9879dad2025-08-20T03:31:20ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622025-06-016670070610.1302/2633-1462.66.BJO-2025-0030.R1Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture?Christopher Gunn0Vivek Thakker1Sophie Williams2Timothy N Board3Henry Wynn-Jones4Jonathan Barrow5Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UKWrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UKInstitute of Medical and Biological Sciences, University of Leeds, Leeds, UKWrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UKWrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UKWrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UKAims: Ceramic bearing fracture is a rare complication following implantation using modern ceramic bearing materials. The ideal revision bearing option in such cases is debated. We aimed to investigate the safety of a hard on soft bearing following ceramic fracture in total hip arthroplasty. Methods: Data on all patients undergoing revision following ceramic fracture between January 2016 and January 2019 were collected retrospectively. Templating software was used to determine linear wear between the first post-revision radiograph and latest available follow-up. Univariate analysis was used to examine patient demographics and the wear rates of the polyethylene components. The intra- and inter-rater reliability of wear measurements was calculated. Additionally, in vitro testing was undertaken to assess the effects on bearing surfaces of residual ceramic particles. Results: A total of 12 patients underwent revision for ceramic fracture in the study period. The mean age at revision was 62 years (54 to 72). There were six liner and six head fractures revised to delta ceramic heads and cross-linked polyethylene acetabular components. At mean follow-up of 3.8 years (0.5 to 6.1), median 4.4 years (IQR 2.0 to 5.1), linear wear rate was calculated at 0.08 mm/year (SD 0.06). Both intra- and inter-rater reliability was excellent with intraclass correlation coefficient (ICC) scores of 0.99 at all timepoints. In vitro testing showed an increase in head roughness in metal on polyethylene bearings after ceramic particles were embedded, but no increase in ceramic on polyethylene (CoP) or ceramic on ceramic bearings. Conclusion: Revision to CoP bearings following ceramic fracture does not cause early catastrophic wear at early follow-up, aligning with the in vitro study observations. It appears safe to use this hard on soft bearing combination, given that wear rates are comparable to what is expected in a primary hip arthroplasty setting. Longer follow-up is required to establish if this trend persists. Cite this article: Bone Jt Open 2025;6(6):700–706.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.66.BJO-2025-0030.R1arthroplastyceramicrevisionthahipfractureceramic on polyethyleneceramic fracturepolyethyleneradiographsmetal on polyethylenetotal hip arthroplasty (tha)intraclass correlation coefficient (icc)ceramic bearingrevision hip arthroplastyprimary hip arthroplasty |
| spellingShingle | Christopher Gunn Vivek Thakker Sophie Williams Timothy N Board Henry Wynn-Jones Jonathan Barrow Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture? Bone & Joint Open arthroplasty ceramic revision tha hip fracture ceramic on polyethylene ceramic fracture polyethylene radiographs metal on polyethylene total hip arthroplasty (tha) intraclass correlation coefficient (icc) ceramic bearing revision hip arthroplasty primary hip arthroplasty |
| title | Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture? |
| title_full | Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture? |
| title_fullStr | Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture? |
| title_full_unstemmed | Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture? |
| title_short | Is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture? |
| title_sort | is it safe to use ceramic on polyethylene bearings in revision hip arthroplasty for ceramic fracture |
| topic | arthroplasty ceramic revision tha hip fracture ceramic on polyethylene ceramic fracture polyethylene radiographs metal on polyethylene total hip arthroplasty (tha) intraclass correlation coefficient (icc) ceramic bearing revision hip arthroplasty primary hip arthroplasty |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.66.BJO-2025-0030.R1 |
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