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Hip prostheses are extremely common in clinical practice, and with an ageing population, prosthesis fracture or failure is a frequent presentation to the emergency department (ED). The history and examination will usually give a clear indication of the diagnosis. Radiography will confirm the diagnosis, as there is usually obvious fracture or displacement. However, this is only true for prostheses that are made of metal or polyethylene. If ceramic is used in the femoral head component of the prosthesis, major prosthetic failure can occur with very subtle radiological abnormality or even normal radiographical appearance. As a result, clinical findings become much more important. This potential pitfall is illustrated by this case report.
A 39-year old man presented to the ED following a fall on to the right hip. He had received a ceramic femoral head prosthesis 8 months earlier without complication. History revealed that he was able to mobilise with slight discomfort but he had the sensation of crepitus and crunching on mobilising. Examination showed no obvious bony tenderness, a limited range of passive …
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