Initial Misdiagnosis of a Traumatic Ceramic Femoral Head Fracture


  • Mohammad Fard-Aghaie
  • Mustafa Citak
  • Joao Correia
  • Carl Haasper
  • Thorsten Gehrke
  • Daniel Kendoff



A destructive ceramic head fracture was diagnosed 1 year after a serious motorcycle accident
in a patient who had undergone primary THA 7 years earlier. 





In the 1970s, Boutin implemented ceramic in modern total hip arthroplasty (THA). Although initial fracture rates of 13.4 % for ceramic heads were described before the 1990s, the inferior rate of wear and friction when compared with metallic heads and the optimized tribology wre promising in THA [1-3]. Gradual improvements in processing of the material led to a significant reduction of the fracture rate to below 0.1 % [3]. Thus, alumina ceramic heads have currently become the standard material in THA with ceramic bearing surfaces.

Nevertheless, multiple case reports have been published describing ceramic head fractures [4-11]. The causes of fractures are diverse and vary from traumatic events [5,9,12,13] to impingement between the neck and the liner rim  [7]. Spontaneous fractures without any history of trauma have also been described [4,6,8,10,11]. However, only two reports describing delayed fractures of ceramic heads were found [12,13].

In this report, we present a 24-year old patient who underwent primary THA at our institution and was a victim of high-energy trauma 7 years later. Initial radiographs were misinterpreted in a non-designated total joint clinic at the time of primary admission (after the accident). A destructive ceramic head fracture was diagnosed more than 1 year after initial trauma at our institution, with major destruction of the ceramic head and the remaining THA.

This was followed by an extensive revision. Based on this experience, the general question of adequate radiographic diagnosis after trauma to a THA, especially one with partial or full ceramic bearing surfaces, will be further discussed in this report.


Boutin P. Total arthroplasty of the hip by fritted aluminum prosthesis. Experimental study and 1st clinical applications. Rev Chir Orthop Reparatrice Appar Mot 1972; 58(3): 229-46.

Fritsch EW, Gleitz M. Ceramic femoral head fractures in total hip arthroplasty. Clin Orthop Relat Res 1996; 328: 129-36.

Willmann G. Ceramic femoral head retrieval data. Clin Orthop Relat Res 2000; 379: 22-8.

Arenas A, Tejero A, Garbayo A, Arias C, Barbadillo J, Lecumberri J. Ceramic femoral head fractures in total hip replacement. Int Orthop 1999; 23(6): 351-2.

Habermann B, Ewald W, Rauschmann M, Zichner L, Kurth AA. Fracture of ceramic heads in total hip replacement. Arch Orthop Trauma Surg 2006; 126(7): 464-70.

Holmer P, Nielsen PT. Fracture of ceramic femoral heads in total hip arthroplasty. J Arthroplasty 1993; 8(6): 567-71.

Hwang DS, Kim YM, Lee CH. Alumina femoral head fracture in uncemented total hip arthroplasty with a ceramic sandwich cup. J Arthroplasty 2007; 22(3): 468-71.

Otsuka NY, Schatzker J. A case of fracture of a ceramic head in total hip arthroplasty. Arch Orthop Trauma Surg 1994; 113(2): 81-2.

Rhoads DP, Baker KC, Israel R, Greene PW. Fracture of an alumina femoral head used in ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2008; 23(8): 1239 e25-30.

Sharma V, Ranawat AS, Rasquinha VJ, Weiskopf J, Howard H, Ranawat CS. Revision total hip arthroplasty for ceramic head fracture: a long-term follow-up. J Arthroplasty 2010; 25(3): 342-7.

Toran MM, Cuenca J, Martinez AA, Herrera A, Thomas JV. Fracture of a ceramic femoral head after ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2006; 21(7): 1072-3.

Anwar I, Bhatnagar G, Atrah S. Delayed catastrophic failure of a ceramic head in hybrid total hip arthroplasty. J Arthroplasty 2009; 24(1): 158 e5-8.

McLean CR, Dabis H, Mok D. Delayed fracture of the ceramic femoral head after trauma. J Arthroplasty 2002; 17(4): 503-4.

Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br 1996; 78(2): 185-90.

Toni A, Traina F, Stea S, et al. Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience. J Bone Joint Surg Am 2006; 4: 55-63.




How to Cite

Fard-Aghaie, M., Citak, M., Correia, J., Haasper, C., Gehrke, T., & Kendoff, D. (2013). Initial Misdiagnosis of a Traumatic Ceramic Femoral Head Fracture. Reconstructive Review, 3(3).



Original Article