Catastrophic wear in uncemented acetabular cups after Total Hip Arthroplasty. A case series

Catastrophic wear is a rare outcome following Total Hip Arthroplasty (THA), documented to happen in less than 0.5% of THA. We present 5 cases of revision THA performed successfully on 5 patients presenting Catastrophic wear, following Total Hip Arthroplasty (THA). Specifically, Catastrophic wear cases were selected, emphasizing differential diagnosis, and a revision THA was performed in all of them and resulted in a good long-term outcome. The purpose of this case series is to contribute to the literature in evaluating both the causes of implant failure as well as the outcomes after their revisions.

We evaluated 5 patients that presented Catastrophic rupture of acetabular implants in a 3-week period in our prosthesis center.

The 5 patients were females, the mean age was 56 years (44-65), the mean post-surgery time was 20 years (17-23), 4/5 of the coupling wear was ceramic-polyethylene and only one case was metal-polyethylene; 4/5 had bilateral total hip replacement. In the 5 cases a revision THA was performed, all with a successful outcome.

Catastrophic failure is an unusual entity; however, when a patient with a prosthesis presents with sudden pain, an immediate image study is indicated, with careful attention to the differential diagnosis, so as to accurately advice receiving a revision THA. The main causes of implant failure are implant duration, volumetric wear and subsequent rupture. Patients with Catastrophic wear and implant rupture, treated with a revision THA, usually have a good long-term outcome.