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Bearing Selection in Hip Revision: Why It Matters for Long-Term Success

Prof. Simon Marmor and team from the Department of Orthopedic Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon in Paris faced an unusual case of a painful hip with tissue pigmentation on a 68-year-old male patient, which had been revised with a metal bearing three years earlier in another institution.

An infographic summarizing the clinical takeaway from a case study on ceramic-on-ceramic bearings in hip revision.

In 2013, the patient had reported a double fracture of both with an insert and head four years after primary elective THA for osteoarthritis.  

His 1st revision operation used cobalt-chrome (CoCr) and polyethylene components. The revision of ceramic fracture with metal bearings is explicitly contraindicated. Existing literature tells us that ceramic bearings in revision after ceramic fracture have proven to ensure durability and reduce complications, the risk of systemic toxicity, and third-body wear.

In this case, the revision with metal bearings resulted in metal wear – including traces of chromium, nickel, and iron – and contributed to metallosis, pain, heightened blood metal ion levels, and an unusual tissue discoloration (a rare post-THA reaction).

After three years, the patient’s hip had to be re-revised. The revision team removed the metal bearings, investigated them, and found excessive wear, trapped particles in the PE liner, and a scratched metal head.

A 2nd revision in 2016 with a CoC bearing couple including a 36mm BIOLOX®delta ceramic revision head and an alumina liner restored both tissue color and ease and range of motion. The patient reported an active lifestyle with a fully functional implant  at eight years post-op.

Based on their experience, the authors emphasize the efficacy of BIOLOX®delta CoC in compensating for prior revision complications and advocates for its use in initial revision surgery.

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References:

Vasileios Giovanoulis, Angelo V. Vasiliadis, and Simon Marmor. “Cutaneous metallosis following ceramic insert fracture in total hip arthroplasty: a case report and revision with ceramic-on-ceramic bearing couple.” SICOT-J, Volume 11. doi: 1051/sicotj/2025007. 

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