A newer alumina matrix composite ceramic (BIOLOX delta; CeramTec, Plochingen, Germany) was developed to improve resistance to wear while reducing the risk for fractures with alumina-on-alumina design. This article describes a case of fracture of the BIOLOX delta ceramic liner without history of trauma in well-fixed total hip implants. A 61-year-old woman underwent total hip replacement via the posterior approach 20 months earlier because of osteonecrosis of the femoral head. A cementless cup and a stem with a 52/36-mm BIOLOX delta couple bearing were used. The authors found signs of stripe wear on the inner surface of the ceramic liner, leading them to believe the possible cause of fracture in this patient was edge loading due to joint laxity. The authors performed revision surgery with the use of another ceramic couple-bearing implant and converted the head component from short to long (+4 mm). More cases should be collected to verify the mechanism of the fracture of the BIOLOX delta ceramic liner with a well-fixed cup.
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