Complete wear-through of a metal-backed acetabular cup in an ambulatory patient

We present a rare case of a patient who presented with complete and rapid wear-through of a ceramic femoral head through a polyethylene liner and titanium acetabular cup. In addition, this patient exhibited significantly elevated serum titanium ion levels, which may serve as a marker of severe metallosis in cases where the preoperative plain radiographs underestimate signs of periarticular metal debris. The unique findings of this case include the rapid (less than 1 year time) wear-through of the femoral head in interval radiographs and the dramatic progression of metallosis and pelvic and femoral osteolysis that required both component revision. In addition, the markedly elevated titanium levels secondary to cup wear-through are also of interest and demonstrate a systemic manifestation of abrasive wear of a titanium alloy component.