Early failure for wear after ceramic-on-highly cross-linked polyethylene total hip arthroplasty: a case report
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(2020) 21:670
CASE REPORT
Open Access
Early failure for wear after ceramic-onhighly cross-linked polyethylene total hip arthroplasty: a case report Chenkai Li and Haining Zhang*
Abstract Background: Highly cross-linked polyethylene (HXLPE) enhances the anti-wear characteristics of the conventional polyethylene (PE). Early failure for wear after ceramic-on-highly cross-linked polyethylene (CoHXLPE) total hip arthroplasty (THA) is extremely rare. Case presentation: We described the case of a 60-year-old man who underwent right CoHXLPE THA because of the developmental dysplasia hip (DDH) complained pain 32 months after this procedure. Plain radiographs showed that eccentric wear existed at the polyethylene insert. However, the patient refused surgery at that time and did not stop weight-bearing. The right hip pain continued for 7 months. Plain radiographs of the pelvis showed that the HXLPE liner was penetrated and partial inner wall of acetabular shell was worn. Acetabular cup revision was performed, and the ceramic head and HXLPE were exchanged. Conclusions: Difficult reduction during primary THA, especially for DDH, can result in higher abductor tension, which may lead to early eccentric wear of the prosthesis. Whenever eccentric wear of HXLPE liner was found, weight-bearing must be stopped to avoid the accelerated wear and adverse reactions to metal debris (ARMD). Keywords: Dysplasia dysfunction of the hip, Ceramic-on-highly cross-linked polyethylene, Total hip arthroplasty, Case report
Background THA is an effective treatment for various end-stage hip diseases, such as osteonecrosis, rheumatoid arthritis, degenerative joint diseases and degenerative diseases caused by developmental dysplasia [1]. Nowdays, because of the improved bearing surfaces and materials, THA lasts longer than before [2]. However, even with these enhancements, failure caused by polyethylene wear, instability, aseptic loosening, malpositioning, and infection is inevitable. Wear debris production from bearing surfaces is regarded as the main factor limiting THA survival. In * Correspondence: [email protected] Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
order to improve the anti-wear characteristics of the conventional PE, HXLPE has been developed to reduce the amount of wear particle production. These improved PEs have shown better wear characteristics in vitro and in vivo [3]. Although it is rare, we found a case of early failure of CoHXLPE bearing only 32 months after THA.
Case presentation A 60-year-old man diagnosed with developmental dysplasia of the right hip (Fig. 1a) underwent CoHXLPE THA through lateral approach (Fig. 1b) at local hospital in 2017. The patient’s first THA as performed by a sophisticated surgeon, although he was admitted in a local hospital. The BMI of this male patient was 22. The DDH classification of the patient was Crowe III, as it can be seen in Fig. 1. The operation time was 75 min,
© The Author(s). 2020 Open Access This article is licens
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