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BioMed Research International
Volume 2013 (2013), Article ID 157247, 8 pages
Review Article

Fracture of Ceramic Bearing Surfaces following Total Hip Replacement: A Systematic Review

1Department of Rizzoli-Sicilia, Orthopaedic Service, The Rizzoli Institute, Bagheria, Italy
2Department of Orthopaedics and Trauma Surgery, Center of Integrated Research (CIR), University Campus Bio-Medico of Rome, Rome, Italy

Received 13 April 2013; Accepted 3 June 2013

Academic Editor: Akihiro Sudo

Copyright © 2013 Francesco Traina et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Ceramic bearing surfaces are increasingly used for total hip replacement, notwithstanding that concern is still related to ceramic brittleness and its possible mechanical failure. The aim of this systematic review is to answer three questions: (1) Are there risk factors for ceramic component fracture following total hip replacement? (2) Is it possible to perform an early diagnosis of ceramic component failure before catastrophic fracture occurs? (3) Is it possible to draw guidelines for revision surgery after ceramic components failure? A PubMed and Google Scholar search was performed and reference citations from publications identified in the literature search were reviewed. The use of 28 mm short-neck femoral head carries an increased risk of fracture. Acetabular component malposition might increase the risk of ceramic liner fractures. Synovial fluid microanalysis and CT scan are promising in early diagnosis of ceramic head and liner failure. Early revision is suggested in case of component failure; no consensus exists about the better coupling for revision surgery. Ceramic brittleness remains a major concern. Due to the increased number of ceramic on ceramic implants, more revision surgeries and reports on ceramic components failure are expected in the future. An algorithm of diagnosis and treatment for ceramic hip failure is proposed.