title: Do Changes in the Production Process Affect the Outcome of Ceramic Liners: A 3-Year Follow-Up Study.
abstract: In 2011, the current liner was withdrawn from the market because of the potential risk for liner fracture secondary to increased pressures used to assemble the metal locking ring. The present study provides a short-term follow-up of patients with this implant.
  
  
  
  We retrospectively evaluated 63 consecutive hips in 53 patients operated by a single surgeon using a recalled ceramic-on-ceramic bearing. There were 30 women and 23 men with an average age of 50.6 years (range 20.3-63.5 years). The mean follow-up was 36.8 months.
  
  
  
  Six hips in 6 patients were revised (9.5%) because of a liner-fracture during the follow-up period. All liner fractures were identified on computer tomography imaging. Nine patients had self-reported episodes of squeaking (14.3%). All 6 patients that underwent revision surgery for liner fracture described squeaking before revision. There were no revisions for other causes. Two of the revised patients had a subsequent dislocation (33%).
  
  
  
  The recalled ceramic liner lots have an increased liner fracture rate. Patients with mechanical symptoms or squeaking should undergo computer tomography to rule out liner facture.
authors.affiliation: Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York; Department of Orthopedics and Tumor Orthopedics, University of Muenster, Muenster, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Schmidt-Braekling
authors.affiliation: Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: Lisa
authors.initials: L
authors.lastname: Renner
authors.affiliation: Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.
authors.forename: Douglas N
authors.initials: DN
authors.lastname: Mintz
authors.affiliation: Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York; Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Wenzel
authors.initials: W
authors.lastname: Waldstein
authors.affiliation: Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Endo
authors.affiliation: Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Boettner
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D002516:Ceramics; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D008670:Metals
keywords: ceramic liner; ceramic-on-ceramic; liner fracture; mechanical symptoms; squeaking