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Early Diagnosis of Ceramic Liner FractureGuidelines Based On a Twelve-Year Clinical Experience
Aldo Toni, PhD; Francesco Traina, MD; Susanna Stea, BSc; Alessandra Sudanese, MD; Manuela Visentin, BSc; Barbara Bordini, MSc; Stefano Squarzoni, MD
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Dec 01;88(suppl 4):55-63. doi: 10.2106/JBJS.F.00587
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Osteolytic lesions due to wear debris are the major long-term problem associated with total hip replacement1. To avoid wear debris, hard-bearing-surface total hip prostheses with improved tribological properties have been introduced into surgical practice. Ceramic surfaces have had some promising long-term results2, and modern metal-backed alumina cups have been associated with very good clinical results3-5.Alumina has excellent tribological properties and a very high Young's modulus that leads to very good compression strength, but it has poor bending strength: it has no way to deform6. This means that ceramic can break without warning. Under normal physiologic conditions, modern ceramics never reach their fatigue limit, so ceramic head fractures are rare (a rate of 0.004%7 in one study). In contrast, ceramic liner fractures are not well recognized, and their frequency could be underestimated (Fig. 1). In addition, it is difficult to identify patients who are at risk because liner fractures can be due to multiple causes: dislocation, impingement, malpositioning, and microseparation8,9.
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