{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:46:51Z","timestamp":1785764811749,"version":"3.56.0"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction and importance:<\/jats:title>\n                    <jats:p>Catastrophic failure of ceramic-on-polyethylene (CoP) total hip arthroplasty (THA) is a rare but severe complication. While ceramics offer superior wear resistance, polyethylene liner degradation can progress silently over decades, culminating in component failure, metallosis, and functional decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Presentation of case:<\/jats:title>\n                    <jats:p>We report the case of a 66-year-old female who presented with pain and mechanical symptoms 20 years after a CoP \u201cDURALOC\u201d Exeter THA. Imaging revealed eccentric polyethylene wear and acetabular osteolysis. Intraoperatively, the ceramic femoral head was found to have eroded through the polyethylene liner and acetabular shell, accompanied by gross metallosis and joint subluxation. Revision surgery involved full component exchange, debridement, and successful reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>This case highlights the potential for catastrophic failure in long-standing CoP implants and emphasizes the importance of long-term surveillance. Despite the durability of ceramic components, polyethylene wear remains a critical factor in implant longevity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Early detection of polyethylene wear is essential to prevent catastrophic failure. Regular follow-up and prompt revision can result in excellent postoperative outcomes, even after severe implant degradation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/rc9.0000000000000012","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T13:04:42Z","timestamp":1768395882000},"page":"59-63","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["The hole story: a case report of a ceramic implant\u2019s unexpected journey"],"prefix":"10.1097","volume":"138","author":[{"given":"Amanda","family":"O\u2019Halloran","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, South Infirmary Victoria University Hospital, Cork, Republic of Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"Guerin","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons in Ireland, Dublin, Republic of Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"R1-20260803","doi-asserted-by":"crossref","first-page":"627\u201332","DOI":"10.1016\/j.arth.2007.04.026","article-title":"Catastrophic failure of ceramic-polyethylene bearing total hip arthroplasty","volume":"23","author":"Needham","year":"2008","journal-title":"J Arthroplasty"},{"key":"R2-20260803","doi-asserted-by":"crossref","first-page":"710\u201315","DOI":"10.1016\/j.artd.2020.07.033","article-title":"A case of titanium pseudotumor and systemic toxicity after total hip arthroplasty polyethylene failure","volume":"6","author":"Tarpada","year":"2020","journal-title":"Arthroplasty Today"},{"key":"R3-20260803","doi-asserted-by":"crossref","first-page":"394\u2013400","DOI":"10.1016\/j.artd.2019.09.008","article-title":"Complete wear-through of a metal-backed acetabular cup in an ambulatory patient","volume":"5","author":"Malahias","year":"2019","journal-title":"Arthroplasty Today"},{"key":"R4-20260803","doi-asserted-by":"crossref","first-page":"812","DOI":"10.3928\/01477447-20080801-35","article-title":"Protrusion of the ceramic head through the acetabular shell in total hip replacement","volume":"31","author":"Tsarouhas","year":"2008","journal-title":"Orthopedics"},{"key":"R5-20260803","doi-asserted-by":"crossref","first-page":"108\u201311","DOI":"10.1016\/S0883-5403(98)90085-7","article-title":"Catastrophic failure of the acetabular component in a ceramic-polyethylene bearing total hip arthroplasty","volume":"13","author":"Simon","year":"1998","journal-title":"J Arthroplasty"},{"key":"R6-20260803","doi-asserted-by":"crossref","first-page":"1\u20134","DOI":"10.3928\/01477447-20090201-08","article-title":"Protrusio of a ceramic femoral head through the acetabular metallic shell, extensive metallosis and \u2018bubble sign\u2019","volume":"32","author":"Malizos","year":"2009","journal-title":"Orthopedics"},{"key":"R7-20260803","doi-asserted-by":"crossref","first-page":"e20469","DOI":"10.1097\/MD.0000000000020469","article-title":"Protrusion of a ceramic femoral head through the acetabular metallic cup in total-hip arthroplasty: a case report","volume":"99","author":"Zhao","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"R8-20260803","doi-asserted-by":"crossref","first-page":"61\u201364","DOI":"10.1007\/s00402-009-0843-7","article-title":"Complete polyethylene wear-through and secondary breakage of the expansion cup in a ceramic-polyethylene total hip arthroplasty","volume":"130","author":"Mariconda","year":"2010","journal-title":"Arch Orthop Trauma Surg"},{"key":"R9-20260803","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1186\/s12891-020-03697-1","article-title":"Early failure for wear after ceramic-on-highly cross-linked polyethylene total hip arthroplasty: a case report","volume":"21","author":"Li","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"key":"R10-20260803","first-page":"51\u201356","article-title":"Catastrophic failure of the acetabular polyethylene liner in ceramic-on-polyethylene total hip arthroplasty","volume":"4","author":"Manzano","year":"2014","journal-title":"J Orthop Case Rep"},{"key":"R11-20260803","first-page":"100079","article-title":"Revised Surgical CAse REport (SCARE) guideline: an update for the age of Artificial Intelligence","volume":"10","author":"Kerwan","year":"2025","journal-title":"Premier J Sci"}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/RC9.0000000000000012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:00:54Z","timestamp":1785762054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/RC9.0000000000000012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/rc9.0000000000000012","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-08-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}