To evaluate the clinical and radiological results of total hip replacement arthroplasty using a cementless, sandwich (alumina-polyethylene-titanium) acetabular component and the cause of three ceramic liner fracture.

From June 1999 to December 2001, one hundred and twenty eight (110 patients) among 146 cases (129 patients) who were underwent total hip replacement arthroplasty using a sandwich type acetabular component, were followed up for minimum 24 months (range, 54-24 months). Among 110 patients, 85 patients (101 cases) were men and 25 patients (27 cases) were women. Their mean age was 48.8 years (range, 17-78 years) old. The patients were examined clinically and radiologically at postoperative 1 month, 3 months, 6 months, 1 year and every year, thereafter.

At the median followup of 32 months, the average Merle d'Aubigne and Postel score had improved from 8.4 to 16.7. Results were graded as excellent in 110 hips (86%), and very good in 18 hips (14%). At the last followup, all component including acetabular cup and femoral stem acquired firm bony union. Neither component migration nor acetabular osteolysis was detected. Finally three fracture and dislocation of ceramic liner developed and the fractured liners were changed other sandwich type or polyethylene liner.

Even though short-term clinical result of total hip replacement arthroplasty using sandwich type acetabular component is excellent, two percent of the ceramic liner fracture incidence is unexpected high. So we have to caution with using sandwich acetabular cup. In addition, ceramic acetabular cup need more precising surgical technique.