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Related Experiment Video

Updated: May 27, 2026

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report
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Factors affecting modular acetabular ceramic liner insertion: a biomechanical analysis.

James P McAuley1, Douglas A Dennis, Justin Grostefon

  • 1London Health Sciences Centre, University Hospital, B9 006, 339 Windermere Road, London, ON N6A 5A5, Canada. James.McAuley@lhsc.on.ca

Clinical Orthopaedics and Related Research
|November 30, 2011
PubMed
Summary

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Misaligned ceramic liner insertion during total hip arthroplasty (THA) significantly increases the risk of liner fracture. Other factors like shell deformation or soft tissue entrapment did not cause fractures in this laboratory study.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Medical Device Engineering

Background:

  • Ceramic liner fracture is a recognized complication in total hip arthroplasty (THA).
  • Identifying factors contributing to ceramic liner fracture risk is crucial for improving implant longevity and patient outcomes.
  • This study aimed to investigate potential causes of fracture under controlled laboratory conditions.

Purpose of the Study:

  • To determine if misaligned liner insertion, acetabular shell deformation, soft tissue entrapment, or taper damage influences ceramic liner fracture during impaction.
  • To assess the effect of impaction number and force on locking taper force and ceramic liner fracture.

Main Methods:

  • Laboratory model simulating intraoperative conditions for total hip arthroplasty (THA).

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  • Impaction and pushout tests were conducted on ceramic inserts within titanium shells under various simulated adverse conditions.
  • Specific tests included misaligned inserts, deformed shells, soft tissue entrapment, taper damage, and a combination of factors.

    • Main Results:

    • Ceramic insert fractures exclusively occurred when the liner was misaligned within the acetabular shell.
    • Increased impact force and number of strikes correlated with higher pushout forces.
    • Deformed shells, soft tissue presence, or taper damage alone did not induce fractures without insert misalignment.

    Conclusions:

    • Misalignment of the ceramic liner during insertion is a primary risk factor for insert fracture in THA.
    • Acetabular shell deformation, soft tissue in the taper, and taper damage appear to be well-tolerated, even under forceful impaction.
    • Repetitive and forceful impaction promotes secure taper engagement and enhances pullout strength.