JBJS 'watch' offers tips for reducing risk of ceramic femoral-head fractures

JBJS Case Connector, an online case report journal published by The Journal of Bone & Joint Surgery, has issued a 'Watch' regarding the rare but potentially catastrophic fracture of ceramic femoral heads used in hip replacements.

Ceramic hip components are often chosen for younger patients to minimize long-term wear. Ceramic femoral head fractures arise mainly from trauma; non-compatible, damaged, or contaminated femoral head/stem taper connections; or material or manufacturing defects.

This Watch was prompted by a case report by Pomeroy et al. in the Dec. 23, 2015 JBJS Case Connector, a report by Heiner and Mahoney in the Oct. 22, 2014 JBJS Case Connector, and a 2014 article in BMJ Case Reports by Tucker and Acharya. Those three reports described patients who experienced ceramic femoral-head fractures anywhere from 10 days to 14 years after hip-replacement surgery.

Because ceramic head fractures are more likely to occur from insults during or after implantation than from manufacturing defects, the Watch includes four "golden rules" surgeons can follow to reduce the risk of these events, including making sure that the tapers on both the head and stem are compatible in all dimensions. The Watch also emphasizes the importance of patient education, during which patients should be encouraged to promptly report any and all postsurgical irregularities.

"The publication of 'Watches' helps fulfill our mission to serve the orthopaedic community," commented Marc Swiontkowski, MD, co-editor of JBJS Case Connector. "The 'Watch' designation may encourage the orthopaedic community to either demonstrate that these are isolated, unrelated cases or sharpen the focus further by rigorously evaluating the intervention and/or reporting related cases."