Stripe Wear - Ceramic on Polyethylene Bearing Surface: A Case Report

Abstract

Background: Stripe wear is a well-known phenomenon that might be caused by rim impingement, edge loading, metal particle entrapment, micro-separation, and transient subluxation. Stripe wear is felt to represent metal transfer and has been associated with squeaking in ceramic-on-ceramic bearings. In our paper, we report the presence of stripe wear on a retrieved modular ceramic femoral head from a patient with ceramic-on-polyethylene-bearing total hip arthroplasty. Method: We report a case of a 57-year-old male who originally had metal-on-metal (MOM) THA and underwent debridement and exchange of the bearing surface from MOM to ceramic-on-polyethylene (COP) articulation for pain and metallosis. He subsequently developed sepsis and underwent resection arthroplasty. Result: Intraoperatively, a cross-table lateral radiograph revealed the forward flexion of the acetabular component and femoral neck to posterior acetabular margin impingement. By analyzing the retrieved components macroscopically and microscopically, linear scars were found on the polyethylene liner, femoral neck, and femoral head in a pattern consistent with the X-ray finding. Conclusion: If metallosis is encountered after THA, the source of the metal wear should be identified. Component malposition is a possible cause, and the surgeon should consider revision or repositioning of the components if evidence of impingement is seen, as a simple bearing exchange may not solve the problem. This report indicates that stripe wear is not limited to ceramic on ceramic articulations.