Alumina femoral head fracture in uncemented total hip arthroplasty with a ceramic sandwich cup

In total hip arthroplasty, insertion of a UHMWPE-coated ceramic sandwich liner dramatically reduces any risk related to the stiffness of the ceramic-ceramic coupling. We present a case of an alumina ceramic head fracture with a ceramic sandwich cup. The fracture occurred 16 months after the initial operation, without trauma. Impingement between the neck and posteroinferior portion of the liner rim had occurred. This was related to the traditional cross-legged sitting position of Koreans, which caused impingement between the neck and liner rim. Consequently, the taper became loose, and the resulting force bent the taper and fractured the head. We examined a peculiar case of ceramic femoral head fracture after implantation of an uncemented total hip arthroplasty with a ceramic sandwich cup and investigated the underlying cause.