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Review Question - QID 157

QID 157 (Type "157" in App Search)
Figure A shows a ceramic head removed during a total hip revision. The component shows damage to the femoral head which was most likely caused by which of the following?
  • A

Third body debris

20%

416/2123

Chronic infection

0%

7/2123

Impingement of the femoral stem neck on the acetabular socket

19%

406/2123

Lift-off separation of the femoral head during hip range of motion

54%

1156/2123

Insertion of the head on the femoral stem at time of initial surgery

6%

133/2123

  • A

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Ceramic-on-ceramic articulation has been an attractive alternative to metal-on-polyethylene articulation because it exhibits low-friction, load-tolerant behavior with satisfactory wear characteristics. Stripe-wear as found in Figure A is a distinct type of impingement from the classic impingement of the femoral head on the acetabular socket found in episodes of instability (ie. lift-off separation) during gait.

Yammamoto et al in a retrieval study of 3 ceramic bearings and found significant stripe scars/wear at the rim of the alumina, but not at the weight bearing portion of the head. They concluded that stripe wear is caused by the femoral head making contact with the rim of the socket when the head undergoes lift-off separation from the socket.

Manaka et al found that the locations of the stripes were similar in retrieved and simulator ceramic heads. However, the stripes from the simulator were narrower than the short-term retrievals and much narrower than some long-term retrievals.

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