HSS What's the Diagnosis Case 160

What’s the Diagnosis – Case 160

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What’s the Diagnosis – Case 160

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What’s the Diagnosis – Case 160

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What’s the Diagnosis – Case 160

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What’s the Diagnosis – Case 160

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What’s the Diagnosis – Case 160

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What’s the Diagnosis – Case 160

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What’s the Diagnosis – Case 160

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What’s the Diagnosis – Case 160

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Findings The radiographs from 2013 to 2021 show very little change. On the AP views of 2021, there is a small lucency about the right sided femoral head. The CT shows that the material for the arthroplasty is less dense than metal implants and there is a striking shattering of the acetabular component.

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Diagnosis: Catastrophic Failure of Acetabular Ceramic Liner Previously presented was a case of a fractured acetabular liner in the setting of a ceramic on ceramic total hip arthroplasty (the ceramic components are less dense than the metal components utilized for THA. Polyethylene when present is very low in attenuation). Different than many of the cases we have presented, this may not have been much of a diagnostic dilemma for many, but it was just the most flagrant, exquisite, catastrophic failure that I have unfortunately seen. The slight lucency on the radiograph is at the interface of some of the fragmented components of the acetabular liner (which has a surrounding titanium belt as seen on the CT). The radiograph belies to a great degree, in my opinion, the extent of the shattering of the acetabular liner.

Much more typically and as seen in an earlier case is a crack of the acetabular liner without the shattering seen here. These situations often present with acute onset of pain and marked squeaking. Early recognition of a liner crack and early revision are warranted to help prevent the scenario presented here with fragmentation and potential destruction of the adjacent bone and soft tissue from the ceramic debris. Interestingly in this patient, the shattering appears to have represented the initial event without a prior cracking of the acetabular liner. The patient underwent revision to a ceramic on polyethylene construct.

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References Delayed diagnosis of catastrophic ceramic liner failure with resultant pelvic discontinuity and massive metallosis. Benjamin A.Winston MD, Ryland P.Kagan MD, Thomas W.Huff MD. Arthroplasty Today Volume 3, Issue 2, June 2017, Pages 77-82 Catastrophic failure of ceramic-on-ceramic total hip arthroplasty presenting as squeaking hip. David Malem, Mathias Thomas Nagy, Sabyasachi Ghosh, Bhavik Shah. BMJ Case Report. Volume 2013

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