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Failure Mechanisms of Ceramic Total Hip Arthroplasty
Francesco M. Benazzo, MD1
1 Clinica Ortopedica e Traumatologica, Universita di Pavia, Fondazione IRCCS, Policlinico San Matteo, Piazzale Golgi, 27100 Pavia, Italy, e-mail: f.benazzo@smatteo.pv.it
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Disclosure: The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received 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, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 May 01;89(5):1131-1132
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To The Editor: What appears most evident in the paper "Ceramic Failure After Total Hip Arthroplasty with an Alumina-on-Alumina Bearing" (2006;88:780-7), by Park et al., is the high percentage of fractures of ceramic components (four liners and two heads out of a total of 357 implants, or 1.7%). The same figures were presented in a poster by Park et al. at the 2006 AAOS annual meeting in Chicago1. Also, on the same occasion, other Korean surgeons presented a similar poster2, in which five of 157 sandwich ceramic liners were reported to have fractured, giving a 3.2% fracture rate. Summing up the experiences of the two groups of surgeons, we calculated a percentage of fractures of 2.1%. The sandwich type of acetabular liner considered in these works has been in use since 1994, and to date more than 20,000 liners have been implanted in Europe, Asia, and Oceania. Excluding those in Korea, twenty-eight fractures of these implants have occurred (a rate of about 0.14%), to our knowledge. In all of the cases examined, the cause of the failure was a subluxation of the head, which often can be traced back to malpositioning of the acetabular cup.
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