Managing total hip arthroplasty failure due to ceramic liner fracture and cup perforation: revision with bone grafting through direct anterior approach

A man in his mid-70s presented with painful right total hip arthroplasty (THA) developed in over 6 months. Clinically, he exhibited significant deambulatory limitations with limb shortening. Radiographs revealed severe wear of the acetabular liner and superior migration of the prosthetic head, leading to metallosis and osteolysis. CT scan confirmed the prosthetic head’s penetration into the acetabular component. A revision THA was performed using a direct anterior approach (DAA), including extensive debridement and bone grafting. Postoperatively, the patient showed significant improvements in hip function. At the 6-month follow-up, the patient was pain-free, with no signs of dislocation or implant failure and had returned to normal daily activities. This case highlights the importance of early detection and intervention in managing catastrophic failures of ceramic-on-ceramic THA and underscores the need for meticulous surgical technique, particularly in component positioning, to prevent such complications.