PMC3426826_01
Anteroposterior pelvic radiograph (24 year old male) after
primary THA for secondary osteoarthritis due to Perthes disease
(Right Hip: cementless CFP stem and TOP acetabular cup; Left
Hip: Hybrid THA with cemented ENDO Mark III stem +
cementless TOP acetabular cup, Waldemar Link GmbH, Hamburg,
Germany).
TOORTHJ-6-362_F1.jpg
PMC3426826_01_TOORTHJ-6-362_F1.jpg
F1
A 24-year old patient with secondary osteoarthritis of the hips due to Legg-Calve-Perthes disease underwent primary hybrid THA of the left hip seven years before trauma, followed by primary cementless THA of the right hip one year later at our institution (Fig. 1) Six years after the right THA, he was involved in a motorcycle accident, in which he suffered direct trauma to this hip, as well as a complex ankle fracture which was treated in a smaller regional hospital on admission.
Conventional pelvic radiographs directly after trauma,
revealing ceramic head fracture.
TOORTHJ-6-362_F2.jpg
PMC3426826_01_TOORTHJ-6-362_F2.jpg
F2
Although initial anteroposterior radiographs of the pelvis and right hip axial views were performed, no signs of fractures, aseptic loosening or implant damage were diagnosed by the attending trauma surgeons (Fig. 2).
Anteroposterior pelvic radiograph eight months after the
initial radiographs, showing a fractured ceramic head.
TOORTHJ-6-362_F3.jpg
PMC3426826_01_TOORTHJ-6-362_F3.jpg
F3
Further conventional radiographs, in two planes, more than a year after the initial radiographs, revealed a completely destroyed multifragmented ceramic head (Fig. 3).
Intra-operative image showing countless debris and the
damaged taper junction of the femoral neck (in situ).
TOORTHJ-6-362_F4.jpg
PMC3426826_01_TOORTHJ-6-362_F4.jpg
F4
Intraoperatively, extensive damage of the ceramic head and correlating taper junction of the femoral neck was found (Figs. 4, 6, 7).
Intra-operative image showing debris with ceramic fragments.
TOORTHJ-6-362_F5.jpg
PMC3426826_01_TOORTHJ-6-362_F5.jpg
F5
Concomitantly, there was severe debris-related metallosis throughout the entire joint (Fig. 5).
Intra-operative image showing the fragmentation of the
ceramic head.
TOORTHJ-6-362_F6.jpg
PMC3426826_01_TOORTHJ-6-362_F6.jpg
F6
Intraoperatively, extensive damage of the ceramic head and correlating taper junction of the femoral neck was found (Figs. 4, 6, 7).
Image showing the explanted components: a fragmented
ceramic head, a damaged stem and acetabular cup and liner.
TOORTHJ-6-362_F7.jpg
PMC3426826_01_TOORTHJ-6-362_F7.jpg
F7
Intraoperatively, extensive damage of the ceramic head and correlating taper junction of the femoral neck was found (Figs. 4, 6, 7).
Postoperative anteroposterior pelvic radiograph.
TOORTHJ-6-362_F8.jpg
PMC3426826_01_TOORTHJ-6-362_F8.jpg
F8
The postoperative course was uneventful, with radiographs revealing a correct position and articulation of the cementless implant (Fig. 8).