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Osteoporosis
1%
13/1666
Corticosteroid treatment
20/1666
Total hip replacement with constrained liner
10%
168/1666
Rheumatoid arthritis
7%
121/1666
Total hip replacement with ceramic bearings
80%
1336/1666
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Ceramic bearings have not been documented to be an etiology for pelvic insufficiency fractures. The review article by Vanderschot describes that constrained liners used with total hip arthroplasty create a mechanical constraint that redistributes more force to the pelvic ring. Pelvic ring insufficiency fractures are increasing in incidence. They commonly present with groin pain in the elderly, but may also be found incidently on radiographs. CT scan, bone scan, and MRI can all be adjuncts to radiographs for diagnosis. Risk factors include osteoporosis, corticosteroid treatment, and rheumatoid arthritis. Illustration A shows a radiograph of a parasymphyseal fracture indicated by the arrows and is a common site for a pelvic insufficiency fracture.
2.6
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