Delayed Presentation of Ceramic Liner Fracture Following Ceramic-on-Ceramic Total Hip Arthroplasty: A Case Report

Ceramic-on-ceramic (CoC) bearings are commonly used in total hip arthroplasty (THA) in younger and more active patients because of their excellent wear characteristics and biological inertness. Although advances in ceramic material science have markedly reduced femoral head fracture rates, ceramic liner fractures remain a rare but clinically important complication. Diagnosis may be difficult, as symptoms can be subtle and imaging findings inconclusive, resulting in delayed recognition.

A 36-year-old male presented with progressive hip pain, painful squeaking, and grinding sensations 13 months after primary cementless CoC THA. Radiographs and computed tomography demonstrated periarticular radio-opacities suggestive of bearing surface failure. Revision surgery revealed an eccentrically fractured ceramic liner with associated ceramic debris. The acetabular shell and femoral stem were retained, and revision was performed using a highly cross-linked polyethylene liner and a ceramic femoral head following meticulous debridement. The patient experienced complete resolution of symptoms and demonstrated a satisfactory outcome at 1-year follow-up.

Ceramic liner fractures may present with non-specific symptoms and subtle imaging findings. Persistent painful squeaking following CoC THA should prompt early clinical evaluation, as timely diagnosis and appropriate revision are essential to prevent catastrophic failure and complex reconstructive surgery.