Massive osteolysis after ceramic on ceramic total hip arthroplasty. A case report.

The case of a 66-year-old woman who sustained a pathologic femur fracture secondary to extensive osteolysis distal to a pressfit femoral prosthesis with a ceramic on ceramic bearing surface is reported. The femoral and acetabular bearing surfaces showed signs of visible wear, although the stem showed little evidence of burnishing. Material curetted from the femoral medullary canal in the area of the osteolysis contained extensive amounts of histiocytes and foreign body debris. Qualitative spectrographic analysis of the curetted material showed levels of aluminum to be approximately 10 times more prevalent than either cobalt or chromium. Although there is little understanding of the cellular reactions to ceramic debris products, the extensive osteolysis seen in this patient suggests that alumina ceramic bearings may not be as biologically inert as initially perceived.