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Prosthetic infection
1%
16/2313
Recurrent dislocations
78%
1799/2313
Leg length discrepancy
2%
37/2313
Ceramic bearing fracture
14%
319/2313
Aseptic lymphocytic-vasculitis-associated lesion (ALVAL)
6%
132/2313
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The markings on the femoral head have previously been described as resembling a pencil lead mark. Its presence indicates transfer of metal from the acetabular cup to the ceramic femoral head. This occurs during the component on component impingement and excursion that occurs during dislocation. Kim et al conducted a retrieval analysis of 15 ceramic femoral heads that had metallic smearing as a result of dislocation. They found statistically significantly more femoral head surface roughness and increased polyethylene liner wear rates as the percentage of metallic smearing surface area increased. Scanning Electron Microscopic (SEM) evaluation commonly showed pits and scratches on the femoral head (Image A) and stereoscopic microscopy shows embedded metallic debris acting as a third body in the polyethyelene.
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