Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component

The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis.