Cutaneous metallosis following ceramic insert fracture in total hip arthroplasty: a case report and revision with ceramic-on-ceramic bearing couple

Ceramic fractures in total hip arthroplasty (THA) are rare complications that pose significant challenges for revision surgery. This case report describes a 68-year-old male who experienced a spontaneous alumina (ceramic) insert and head fracture four years after the initial THA. The first revision with cobalt-chrome and polyethylene components led to severe metallosis, including subcutaneous tissue discoloration. A second revision utilized a ceramic-on-ceramic (CoC) bearing couple, resulting in excellent functional outcomes and resolution of symptoms. Cutaneous pigmentation post-THA is rare and has not been previously reported following a ceramic fracture. The case underscores the need for careful material selection in revision surgery to minimize complications such as metallosis. The decision to use a ceramic-on-ceramic bearing couple in this case proved effective, ensuring durability and reducing the risk of third-body wear, which can result from inadequate management of ceramic fractures and lead to joint, systemic, or cutaneous complications.