title: Long Term Survivorship of a Severely Notched Femoral Stem after Replacing the Fractured Ceramic head with a Cobalt-Chromium Head.
abstract: BACKGROUND
  Although ceramic head fracture occurs infrequently today, in the event of a fracture, the resulting revision surgery can prove very challenging, since the ceramic particles lodge into the surrounding soft tissue and can cause rapid implant failure.
  
  
  METHODS
  A case of long term survivorship of a severed notched femoral stem after replacing the fractured femoral head with a cobalt-chromium one is reported in a 40-year old woman with hip dysplasia who underwent an uncomplicated total hip arthroplasty. The incident of ceramic femoral head fracture occurred 14 months postoperatively without reporting any significant trauma. Intraoperative findings at revision were a multifragmented femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt-chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At the 13thyear follow up examination, the patient had no pain, used no walking aids, and had normal activity with no signs of wearing or loosening in the plain x-rays.
  
  
  CONCLUSIONS
  Despite current recommendations of using ceramic femoral heads in cases of fracture or to revise the severely damaged stems we were able to provide a long term survivorship up to 13 years postoperatively of a cobalt-chromium femoral head applied to a severe damaged stem.
authors.affiliation: University Hospital of Patras, Adult Reconstructive Surgery Patras, Achaia, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Panagopoulos
authors.affiliation: University Hospital of Patras, Adult Reconstructive Surgery Patras, Achaia, Greece.
authors.forename: Irini
authors.initials: I
authors.lastname: Tatani
authors.affiliation: University Hospital of Patras, Adult Reconstructive Surgery Patras, Achaia, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Megas
keywords: Ceramic Head Fracture; Hip Arthroplasty; Long Term Survivorship; Metallic Head; Notched Stem; Revision Surgery