Recurrent Ceramic Femoral Head Fracture in Dual Mobility Total Hip Arthroplasty: A Case Report

Ceramic femoral heads reduce wear in total hip arthroplasty (THA), yet fracture remains a rare but serious complication. Reports almost exclusively concern ceramic-on-ceramic bearings; cases in dual mobility constructs are exceptional. We describe, to our knowledge, the first report of two successive ceramic femoral head fractures occurring in the same dual mobility hip in a single patient, and we outline plausible mechanical contributors.

Sixty-six-year-old White European man with no major comorbidities underwent primary THA with a dual mobility construct at another institution. Ten days later, he developed mechanical pain and audible noises without trauma; imaging demonstrated a ceramic femoral head fracture. Urgent revision replaced the acetabular component and femoral stem, and a new ceramic head was implanted; recovery was initially satisfactory. Twenty-two months later, during a torsional movement without high-energy trauma, he experienced sudden pain and functional impairment of the same hip. Imaging again confirmed a ceramic femoral head fracture. At re-revision, fragmented ceramic debris was found; the acetabular shell and the trunnion were intact and well fixed. The ceramic head was exchanged for a cobalt-chromium head with a compatible polyethylene insert, with extensive irrigation. Eight months later, he was pain-free with a full range of motion and returned to normal activities. The patient's ethnic background was not recorded.

This case shows that dual mobility constructs are not immune to ceramic femoral head fracture and that recurrence is possible even with correct component positioning. The combination of increased femoral offset and an extended ceramic head, particularly in a patient with elevated body mass index, may raise stresses at the head-trunnion junction and precipitate failure. Clinicians should weigh patient and implant-related mechanical demands when selecting ceramic heads for dual mobility constructs and consider alternatives when risk appears high.