Wear-related complications are a major cause for revision total hip arthroplasty. Alternative bearing surfaces have increased the longevity of total hip replacements and decreased the need for revision surgery. Oxidized zirconium is advertised as a wear- and abrasion-resistant surface with a metal core that decreases brittleness. Laboratory tests have shown that oxidized zirconium heads result in 4,900 times less volumetric wear and 640 times fewer deep scratches than cobalt-chromium alloys. However, case reports of retrieved oxidized zirconium heads suggest that dislocation with damage to the surface of the oxidized zirconium head leads to accelerated polyethylene wear. This wear results in osteolysis and, potentially, diffuse metallosis. Diagnosis of osteolysis and metallosis must be performed in a stepwise manner, ruling out other causes of failure.

This video demonstrates the workup, surgical treatment, and mechanism of failure for patients with extensive osteolysis and metallic debris after total hip arthroplasty with an oxidized zirconium head. This video provides an overview of the pathogenesis, diagnosis, and management of polyethylene wear and advanced oxidized zirconium metallosis followed by a discussion of the technical pearls for management of severe osteolysis and metallic debris. The video discusses the case presentation of a 55-year-old woman with left hip pain 9 years after bilateral staged total hip arthroplasty with oxidized zirconium heads. Radiographs revealed a flattened femoral head on the left side and extensive osteolysis. The patient denied trauma and dislocation events. An infectious and systemic metal-ion workup was negative. Advanced imaging studies and aspiration revealed extensive metallosis with loosening of the femoral and acetabular components. Revision arthroplasty of the femoral and acetabular components was performed. Excellent restoration of hip stability and pain relief were achieved. The patient was advanced through a standardized rehabilitation protocol. At 6 months postoperatively, the patient was ambulating well and reported no subsequent dislocation events or signs of loosening.

Oxidized zirconium is a viable bearing surface that increases longevity and decreases wear in patients who undergo total hip arthroplasty. However, implant positioning and stability are paramount given the material’s susceptibility to damage with dislocation and impingement.