Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience,

steolytic lesions due to wear debris are the major long-term problem associated with total hip replacement1. To avoid wear debris, hard-bearing-surface total hip prostheses with improved tribological properties have been introduced into surgical practice. Ceramic surfaces have had some promising long-term results2, and modern metalbacked alumina cups have been associated with very good clinical results3-5. Alumina has excellent tribological properties and a very high Young's modulus that leads to very good compression strength, but it has poor bending strength: it has no way to deform6. This means that ceramic can break without warning. Under normal physiologic conditions, modern ceramics never reach their fatigue limit, so ceramic head fractures are rare (a rate of 0.004%7 in one study). In contrast, ceramic liner fractures are not well recognized, and their frequency could be underestimated (Fig. 1). In addition, it is difficult to identify