Severe Wear and Metal Poisoning in Revision Surgery after Ceramic Fracture Treated with Dual Mobility Prosthesis

Abstract

The aim of this study was to analyze the outcomes of revision surgery for a broken ceramic when using a dual- mobility (DM) implant with a metallic inner head (CoCr). A retrospective analysis was conducted on 225 cases utilizing DM implants to evaluate complications. In cases where DM was used to treat a prior ceramic fracture, we assessed clinical outcomes, wear patterns, and metal-ion levels. Three cases requiring revision after ceramic fracture presented accelerated wear and marked metal-ion elevations, leading to significant morbidity and mortality. Metal debris and ceramic fragments were observed embedded in the polyethylene surfaces of the implants, particularly affecting the metal heads. Symptoms of systemic metal toxicity included fatigue, anorexia, auditory and visual symptoms, and cardiac complications. The use of DM prostheses following ceramic fractures poses significant risks of accelerated wear and metal poisoning. Notably, wear is much more pronounced in the internal metal head than in the insert. Clinical vigilance is essential to detect and manage complications promptly. After meticulous debridement, ceramic-on-ceramic or ceramic-on-polyethylene remain reasonable alternatives; our findings should not be generalized to standard DM applications.