Sandwich liner fracture after 21 years from revision total hip arthroplasty: a case report

Introduction Ceramic-polyethylene sandwich liners were introduced to reduce fracture, but high failure rates were reported. We report a fracture clinically recognized 21 years after revision total hip arthroplasty (THA). Case Presentation A 64-year-old man presented with two weeks of hip pain, clicking, and gait disturbance without trauma. He underwent primary THA for secondary coxarthrosis after slipped capital femoral epiphysis and revision THA for aseptic loosening three years later. Radiographs demonstrated eccentric femoral-head migration and radiopaque fragments. Computed tomography confirmed ceramic layer fracture and migration into the obturator internus muscle. Management and Outcomes Re-revision of the acetabular cup with a fourth-generation ceramic articulation was performed, with the well-fixed femoral stem retained. At 43 months, he returned to recreational hiking; the modified Harris Hip Score improved from 42.9 to 87.5. Residual fragments remained stable. Conclusion Long-term surveillance and prompt evaluation of mechanical symptoms are advised for older-generation sandwich liners.