title: High rate of ceramic sandwich liner fracture.
abstract: BACKGROUND
  Ceramic bearing surfaces for THA were introduced to reduce the risk of wear. However, owing to liner fracture in some of the early series and presumption that the fractures were the result of the modulus mismatch of the implant and the bone, a ceramic sandwich liner with lower structural rigidity was introduced. Fractures of these devices also were reported subsequently, although the incidence is unclear and it is unknown whether there are any risk factors associated with the fractures.
  
  
  OBJECTIVE
  We therefore determined the incidence of these fractures.
  
  
  METHODS
  We retrospectively reviewed 298 active patients in whom we implanted 353 ceramic-polyethylene sandwich liner acetabular components between November 1999 and February 2008. The mean age of the patients was 53.6 years (range, 17-84 years). The minimum followup was 6 months (mean, 41 months; range, 6-106 months). All patients were assessed clinically and radiographically.
  
  
  RESULTS
  Seven of the 353 (2%) ceramic sandwich liners fractured at a mean of 4.3 years (range, 1.3-7.6 years) after surgery without trauma. Neither patient-related factors nor radiographic position of the implants were risk factors for fracture.
  
  
  CONCLUSIONS
  Owing to the high rate of fractures of the sandwich ceramic polyethylene liners in our patients, we have discontinued use of this device.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Hotel Dieu Hospital, Rue Gaston-Viel, 44000, Nantes, France.
authors.forename: Ronny
authors.initials: R
authors.lastname: Lopes
authors.forename: Jean M
authors.initials: JM
authors.lastname: Philippeau
authors.forename: Norbert
authors.initials: N
authors.lastname: Passuti
authors.forename: François
authors.initials: F
authors.lastname: Gouin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D002516:Ceramics; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure; D055815:Young Adult
chemical_list: D020959:Polyethylene