Fracture of ceramic components as a serious failure after total hip replacement with ceramic-on-ceramic bearings

Introduction Ceramics have been introduced in total hip arthroplasty for several advantages including minimal friction, low wear, biocompatibility, no ageing problems and no problems related to the systemic increases in serum metal concentrations. In the first generation of ceramic components introduced in the 1970’s the risk of fracture was substantial, reaching up to 13.4 %. After introducing the ISO 6474 standard in 1980s, the rate of fracture failure decreased in the last two decades. These favorable results have led to the increased use of alumina-onalumina bearings as an alternative to a conventional metal-onpolyethylene articulation, particularly for young, active patients. Midterm results for the third generation of ceramic-on-ceramic bearings are encouraging, with rare incidence of component fractures. It was recently reported, however, that high number of ceramic fractures (1.4% up to 6.1%) occurred in the series of contemporary alumina-on-alumina bearings. Such high number of ceramic fractures was associated with repetitive impingement due to extensive anteversion of cup during squatting or cross-leg sitting characteristic for Asian patients.