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Despite the major improvements in ceramic bearing design, fractures can still occur. The development of the 4th-generation BIOLOX delta ceramic heads has reduced fracture rates to 0.001%; however, the risk, though extremely low, has not been entirely eradicated. We present a case report of a 53-year-old man who suffered an atraumatic breakage of a BIOLOX delta ceramic femoral three years postoperatively. Anamnestic and physical examination revealed a sensation of walking on gravel and a painful hip mobilization. Revision surgery involved a synovectomy and removal of ceramic fragments, followed by a replacement of the ceramic femoral head and poly-ethylene acetabular liner. The patient recovered well, with an uneventful follow-up. This case adds to the scarce literature concerning atraumatic breakage of the latest generation BIOLOX ceramic head. To the best of our knowledge, only three prior cases have reported such fractures in a primary total hip replacement (THR) using ceramic-on-polyethylene (CoP) bearings.

Keywords: Ceramic head failure in THR