Management and Outcomes of Breakage in Polyethylene-Ceramic Composite (Sandwich-type) Liners: Lessons From Long-term Follow-up

• Published in: Arthroplasty today Vol. 33; p. 101698
• Main Authors: Rodríguez, Daniel, Carnaval, Thiago, Rodríguez, Marcos-del-Carmen, Maña, Antonio Coscujuela, Agulló, José-Luis, Videla, Sebastián
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2025; Elsevier
• Subjects: Case Report; Hip arthroplasty; Long-term; Polyethylene; Primary THA; Sandwich-type liners; Long-term; Polyethylene; Primary THA; Sandwich-type liners; Hip arthroplasty
• ISSN: 2352-3441; 2352-3441
• DOI: 10.1016/j.artd.2025.101698

This case series reports the only 3 instances of ceramic liner breakage among patients who underwent total hip arthroplasty (THA) with polyethylene–ceramic composite (sandwich-type) liners at our center between 1999 and 2002. Breakages occurred at approximately 6 (n = 2) and 17 years (n = 1) after the primary THA. Symptoms included audible crepitation, pain, and restricted motion during normal activities. Surgical revisions utilized a polyethylene liner and third-generation alumina ceramic head, with synovectomy and irrigation to remove debris (preventing third-body wear). All patients achieved good long-term outcomes. Although infrequent, the risk of breakage increases over time, and several patients still carry these liners years after THA. This case series underscores the importance of vigilant follow-up, patient education, and timely intervention to manage this infrequent but potentially catastrophic complication.