Topic Ceramic on Ceramic

Executive Summary

Pearls: How to remove a ceramic liner from a well-fixed acetabular component

Rocco P. Pitto MD, PhD, FRACS
Clin Orthop Relat Res (2016) 474:25–26 / DOI 10.1007/s11999-015-4617-y
Level of Evidence:
None. Expert opinion.


In the rare event that revision of a ceramic liner is necessary, dissociation of the liner from the metal cup can be difficult. In order to avoid unnecessary removal of the liner with the cup, Pitto describes a simple procedure. Quote: “Using a metallic impactor placed along the external rim of the cup, the surgeon can hit the metal cup rim with a robust hammer blow. The ceramic liner will dissociate from the internal metal surface. A sharp tool will be necessary to elevate the loosened ceramic liner from the cup margin”. The author states that there may be a few acetabular designs that require more than one hammer blow to achieve liner dissociation.

According to the author the explanation of this technique are elasto-dynamic compressive stress waves, which are initiated by the impact on the rim of the metal shell. These stress waves are reflected at physical boundaries and transformed into tensile stress waves. These, if they exceed the local stresses resulting from friction and adhesion at the taper junction, will lead to a separation of the taper interface.

The author stresses the importance of choosing compatible components, because a wrong liner can result in a disaster. Never mix and match!

Study limitations

Key Messages


This expert opinion can be of help for surgeons facing the situation to remove a well seated ceramic liner. However, they need to be cautious about possible damages inflicted on the metal shell. If its taper is damaged using a ceramic insert as replacement is not recommended.

Personal Comment (Kiefer)

Instead of using a sharp instrument to remove the loosened liner you can use a syringe with saline and flush the liner out.


This article reflects the medical and scientific experiences of the author. It does not replace the instruction for use. The information given in the instruction for use is binding and must always be observed.

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