Clinical History, Examination and Blood Test Result

  • Case 3 is a 51-year-old male who experienced a jarring of his left leg 2 years after a ceramic-on-ceramic hip replacement. He described the noise his hip joint made as similar to a “rustic gate” and it was causing him discomfort with restricted motion.

  • On examination, he found it painful to stand on his left leg and all movements of his left hip were mechanically abnormal and uncomfortable. He found it difficult to climb stairs at home, but he was neurologically intact with a good muscle mass.


Imaging Results

PRE-OP CT

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This pre-operative CT scan showed evidence of the ceramic fracture within the acetabular liner.

 

EVIDENCE OF CERAMIC FRACTURE

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The fracture lines are highlighted by the red arrows. This is a series of three images taken from the pre-op CT scan to highlight the fracture.


Diagnosis

  • Fractured left ceramic-on-ceramic hip replacement requiring revision with liner exchange.


Treatment

  • This patient underwent a revision of his left ceramic-on-ceramic total hip replacement. The stem and acetabular cup were retained however the ceramic components were replaced in a liner exchange.


Imaging Outcomes

POST-OP RADIOGRAPH 

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The ceramic liner was replaced.

 

Clinical Outcomes

  • Examination one-year post-operatively is very satisfactory, with the patient happy with his level of hip function. He was able to use an exercise bike.


Learning Points

  • Ceramic fractures can be detected on radiographs and on CT scans. They normally present with sound from the bearing and abnormal mechanical symptoms.