J Korean Hip Soc.  2011 Dec;23(4):282-289. 10.5371/jkhs.2011.23.4.282.

Isolated Polyethylene Liner Exchange in a Revision Total Hip Arthroplasty

• Cho YJ
• Kwak SJ
• Chun YS
• Rhyu KH
• Kang DG
• Yoo MC

• KMID: 1452636
• DOI: http://doi.org/10.5371/jkhs.2011.23.4.282

Abstract

PURPOSE
To analyze the results of isolated exchange of polyethylene (PE) liners for treatment of wear and osteolysis around a well-fixed Harris-Galante (HG) cementless acetabular cup.
MATERIALS AND METHODS
Thirty-three PE liner changes were performed without the removal of stably ingrown implants (33 hips of 32 patients). They were able to be followed for a mean period of 92 months. Clinically, the Harris hip score (HHS), pain evaluation, and complications were evaluated. Radiologically, the annual wear rate and the size of the osteolytic lesions were measured before the operation and the latest follow-up. The bone graft incorporation scale and the development of new osleolytic lesions were checked during the final follow-up.
RESULTS
HHS improved to 89.3 at last follow-up. The size of the osteolysis was significantly reduced postoperatively. Bone graft incorporation scales were Grade I in 9 and Grade II in 14 cases. New osteolytic lesions have not developed at latest follow-up. As a complication, one case of dissociation of a liner and a periprosthetic fracture were noted. Annual wear rates during the same period were significantly reduced. There was no sign of alteration in stability of the PE liner.
CONCLUSION
Exchange of a PE liner without removal of stable implants can be a good option for the treatment of wear and osteolysis around a stable cementless THA implant, even if the system has a weak locking mechanism, such as the HG cup. In these cases, under certain states with a higher risk of early failure in the locking mechanism, it would be better to select other revision procedures such as cup revision or cemented polyethylene liner fixation.

Keyword

Cementless acetabular cup; Harris-Galante; Exchange of polyethylene liner; Revision total hip arthroplasty

MeSH Terms

Arthroplasty
Dissociative Disorders
Follow-Up Studies
Hip
Osteolysis
Periprosthetic Fractures
Polyethylene
Tacrine
Transplants
Weights and Measures
Polyethylene
Tacrine

Figure

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  Fig. 1 The annual linear wear rate of polyethylene liner was estimated by the method of Dorr.

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  Fig. 2 A 70-year-old male. (A) Preoperative anteroposterior (AP) radiography, taken at 5 years after the initial operation, demonstrated dislodging of the polyethylene liner and osteolysis around the acetabular cup. (B) Postoperative AP radiography. Polyethylene insert and head were changed. Osteolytic lesion was curetted and filled with bone graft. (C) AP radiography taken at 7 years after bone graft showed complete incorporation of the grafted bone to the host bone.

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  Fig. 3 A 27-year-old male. (A) Preoperative anteroposterior (AP) radiography, taken at 6 years after the initial operation, demonstrated marked wear of the polyethylene liner and osteolysis around the acetabular cup. (B) Postoperative AP radiography. Polyethylene insert and head were changed. Osteolytic lesion was curetted and filled with bone graft. (C) AP radiography, taken at 6 years after bone graft, showed complete incorporation of the grafted bone to the host bone.

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  Fig. 4 A 54-year-old female. (A) Polyethylene liner dislodging (empty arrow) had been happened 2 years after revision surgery, polyethylene liner and head change. (B) The acetabular cup was changed to another cementless acetabular cup using circumferential medial wall osteotomy (filled arrow). (C) Successful cup positioning and bony union of medial wall osteotomy site were noted 6 years follow-up radiograph.

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