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Ceramic-on-ceramic failure secondary to head-neck taper mismatch.

We report a case of catastrophic failure of ceramic-on-ceramic total hip arthroplasty without precipitating event or trauma. The patient was a 64-year-old woman who had degenerative osteoarthritis and underwent the index primary total hip arthroplasty 3 years earlier. Intraoperative findings included an intact ceramic femoral head, a slightly damaged ceramic liner insert, diffuse metallosis, and excessive wear of the trunnion of the stem. After removal of the metallic debris, excision of metalloid tissue, and copious lavage of the joint, the prosthesis was revised to a modular revision system. Although previous operative reports had been reviewed before surgery, there was no indication of a head-neck taper mismatch. Only after revision surgery was performed, and high suspicion arose, were previous implant records analyzed and the mismatch identified.