Catastrophic Failure of the Acetabular Polyethylene Liner in Ceramic-on-Polyethylene Total Hip Arthroplasty

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What to Learn from this Article?

Unusual and Rare Complication of THR with its Management.

Case Report |  Volume 4 | Issue 2 | JOCR April-June 2014 | Page 51-56 | Manzano G, Levine Rayna AC, Mayor MB, Schwarzkopf R. DOI: 10.13107/jocr.2250-0685.168

Authors: Manzano G[1], Rayna A. C. Levin[2], Michael B. Mayor[2], Ran Schwarzkopf[1]

[1] Department of Orthopaedic Surgery, University of California Irvine Medical Center.
[2] Dartmouth Biomedical Engineering Center, Thayer School of Engineering, Dartmouth College.

Address of Correspondence:

Dr. Ran Schwarzkopf, Department of Orthopaedic Surgery, University of California Irvine, 101 The City Drive South, Orange, CA 92868. Phone No. 714 456 5759. E-mail:


Introduction: Catastrophic polyethylene failure is a rare complication of ceramic-on-polyethylene total hip arthroplasty due to the favorable tribological characteristics of ceramic.  Failure of the polyethylene liner can be disastrous, increasing periprosthetic osteolysis, metallosis, and risk of dislocation.  Complications associated with ceramic-on-polyethylene articulations have been studied extensively, however, only few reports have described its catastrophic wear.  We report such a case of complete wear of the acetabular liner in a ceramic-on-polyethylene prosthesis in a 57-year adult male.

Case Report: A 57-year adult male with a history of bilateral total hip arthroplasty presented to our institution with bilateral hip pain worst on the right. Range of motion was limited by pain on the right hip at the extremes of motion.  Radiographs revealed severe osteolysis, heterotopic ossification, complete wear of the acetabular liner, bony impingement of the femoral greater trochanter on the acetabular rim and superior migration of the femoral head. All findings were confirmed intraoperatively. Revision of the acetabular components was performed, which successfully alleviated the patient’s symptoms.

Conclusion: Failure of the ceramic-on-polyethylene liner in our patient is due to the use of a non-cross linked polyethylene liner, a highly active lifestyle, and poor follow up.  Arthroplasty surgeons should be aware of this complication especially in highly active patients with a conventional polyethylene liner and chronic hip pain.

Keywords: Total hip arthroplasty; polyethylene wear; ceramic femoral head; metallosis; osteolysis.

How to Cite This Article: Manzano G, Levine Rayna AC, Mayor MB, Schwarzkopf R. Catastrophic Failure of the Acetabular Polyethylene Liner in Ceramic-on-Polyethylene Total Hip Arthroplasty. Journal of Orthopaedic Case Reports 2014 April-June;4(2): 51-56. Available from:

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