Late-onset atraumatic ceramic head fracture in a ceramic-on-ceramic total hip arthroplasty: a case report

Ceramic-on-ceramic bearings are widely used in total hip arthroplasty (THA); although rare, ceramic femoral head fracture represents a serious complication. This event typically occurs early or after trauma, whereas atraumatic late-onset fractures confined to the femoral head component are exceedingly uncommon. A 73-year-old patient developed sudden-onset hip pain and functional impairment 11 years after a primary ceramic-on-ceramic THA. The patient denied any preceding trauma. Radiographs demonstrated multiple ceramic fragments without clear identification of the donor site; intraoperative inspection confirmed a fractured femoral head with an intact liner. Revision surgery was performed with complete removal of ceramic debris and exchange to a new ceramic femoral head using a taper adapter while preserving the well-fixed stem. The postoperative course was uneventful, and the patient regained satisfactory function at follow-up. This case represents an exceedingly rare late atraumatic fragmentation of a ceramic femoral head in a ceramic-on-ceramic THA, with successful stem-preserving revision despite extensive intra-articular ceramic debris. Orthopedic surgeons and musculoskeletal radiologists should remain vigilant for this possibility in patients presenting with acute hip symptoms years after implantation. Prompt recognition and revision surgery are essential to achieve favorable outcomes.