Massive metallosis after revision of a fractured ceramic head onto a metal head

We report a case in which metallosis occurred due to a ceramic head fracture after revision of a total hip prosthesis. In the primary revision, after retrieval of the head fragments, the firmly incorporated stem was left in place, the PE inlay was replaced, and a metal head was inserted. Subsequently, massive metallosis occurred, leading to loosening of the stem and necessitating a two-stage revision. Examinations of the explanted material showed that microparticles of the fractured ceramic head had come to rest in the new PE inlay, where they led to wear on the metal head. We conclude that the use of a metal/PE articular pairing is contraindicated after a ceramic head fracture and recommend the use of a ceramic/ceramic articular pairing in the event of revision. In the case of the stem remaining in situ, this procedure requires the use of a conical stem adapter in order to minimise the fracture risk of the new head.