Catastrophic failure of an acetabular total hip arthroplasty component mimicking a posterior dislocation

Joyce, Christopher D.; Harwood, Jared L.; Glassman, Andrew H.

doi:10.1016/j.artd.2016.09.010

Cited by 6 publications

(15 citation statements)

References 18 publications

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“…Total hip arthroplasty dislocation is a common complication, especially in the early postoperative period, with a reported incidence of 1.1%-4.76% [ 4 ]. On the contrary, the incidence of a chronically dislocated prosthesis is rare and increased suspicion is needed in such cases.…”

Section: Discussionmentioning

confidence: 99%

“…It is worth noting that the incidence of total hip replacement dislocation is only 0.92% after the second year of the surgical intervention [ 5 ]. The published cases in the current literature with a chronic total hip replacement dislocation are less than ten, so increased awareness is needed before settling such a diagnosis [ 4 ]. The evidence-based risk factors for total hip arthroplasty dislocation are the increased age, rheumatoid arthritis, femoral head less than 28 mm, and posterior surgical approach [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Catastrophic Wear of an Acetabular Component Misdiagnosed as Total Hip Arthroplasty Dislocation

Papaioannou

Πανταζίδου

Chatziperi

et al. 2020

Cureus

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Total hip arthroplasty constitutes the operation of the century, although not without complications, which require revision surgery due to loosening, infection, dislocation, and wear. Hereby, we report a rare case of acetabular shell wear misdiagnosed as a dislocation. Patients who underwent total hip arthroplasty with ultra-high molecular weight polyethylene are more vulnerable to excessive wear, and close monitoring can prevent this catastrophic sequence. Timely and accurate diagnosis is mandatory to avoid any unnecessary interventions, such as useless reduction attempts. An anteroposterior radiograph is valuable, although computed tomography can settle the diagnosis with accuracy. Evaluation of any previous radiographic examination is very helpful to highlight any differences. Metal debris shown in the joint space, the bubble sign, and also the eccentric location of the prosthetic head are very helpful signs of the catastrophic wear presented to the X-rays. Since late onset dislocations are rare, orthopedic surgeons should be aware that catastrophic wear of the polyethylene and subsequently the acetabular shell can be presented as a late onset dislocation or protrusion. Furthermore, arthroplasty surgeons should adequately monitor patients who underwent hip arthroplasty with this particular polyethylene type.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Catastrophic Wear of an Acetabular Component Misdiagnosed as Total Hip Arthroplasty Dislocation

Papaioannou

Πανταζίδου

Chatziperi

et al. 2020

Cureus

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“…Prosthetic hip dislocation is a differential diagnosis, necessitating astute clinical acumen to differentiate this from liner dissociation. Clinical and radiographic findings can be misinterpreted for hip dislocation [ 17 ]. Inferior liner displacement following liner dissociation results in asymmetric placement of the femoral head in the acetabular component, apparent on plain radiograph.…”

Section: Discussionmentioning

confidence: 99%

“…Although the United Kingdom and Australian registry data demonstrates survivorship of the DePuy Pinnacle acetabular cup system comparable with other implants, it is prudent for clinicians to be aware that liner dissociation is a complication documented in the literature somewhat more frequently than with other modular implant systems [ 3 , 10 , 12 , 13 , 17 ]. It remains, however, a rare complication and this prosthesis has an excellent track record among registry data historically.…”

Section: Discussionmentioning

confidence: 99%

The Utility of a Plain Film Arthrogram to Confirm Acute Liner Dissociation in the Setting of Primary Total Hip Arthroplasty

McQuail¹,

Miller²,

Nolan³

et al. 2020

Cureus

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Acute Liner dissociation is a well-documented, but uncommon complication of total hip arthroplasty, yet the journey to diagnosis remains undefined. This clinical case report outlines the use of plain film arthrogram for diagnosis in a 53-year-old female who presented to the ED following a fall, describing symptoms of increasing groin pain, reduced range of movement, difficulty weight-bearing and a grinding sensation in her left hip, all on a background of total hip replacement two years ago. Examination revealed impaired flexion, rotation and abduction while AP pelvic X-ray confirmed mild eccentric placement of the femoral head, and lateral X-ray proved joint enlocation. An arthrogram of the left hip was performed the following day with injection of 4mls of iodinated contrast injected into the joint. Inferior dissociation of the liner from the shell was evident. The femoral head and liner were replaced two days later, and the liner was found to have shearing and gross plastic deformation at the rim. The patient reported immediate relief from the groin pain and was discharged on the fourth day postoperatively. This shows how plain film imaging fails in diagnosing acute liner dissociation dynamic fluoroscopic tests, post-arthrography CT and metal artifact reduction sequence magnetic resonance imaging (MARS MRI) have previously been proposed despite their associated wait-time, radiation exposure and financial costs. This case report highlights the role of plain film arthrography as a low risk and low-cost diagnostic tool. The report also suggests the incorporation of radio-dense markers in liners to facilitate the use of arthrography when diagnosing dissociation, also raising awareness of prevention and recognition in what may be an under-reported complication of hip arthroplasty.

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“…In addition to mechanical properties and biocompatibility, the FCG resistance of materials is also a factor that designers must consider because many UHMWPE components are designed with notches for fixation and improved motion stability, such as acetabular liner locking mechanisms in hip replacement and tibial posts in knee replacement (Birman, Noble, Conditt, Li, & Mathis, ; Chiu, Chen, Huang, Chiang, & Chen, ; Furmanski et al, ; Kurtz et al, ). Stress concentration exists in these notches with specific functions, from which cracks often initiate and propagate, leading to catastrophic damage of UHMWPE implants (Furmanski & Rimnac, ; Joyce, Harwood, & Glassman, ). According to previous studies, great effort has been put on the research of FCG of UHMWPE and its modified materials.…”

Section: Introductionmentioning

confidence: 99%

Biaxial fatigue crack propagation behavior of ultrahigh molecular weight polyethylene reinforced by carbon nanofibers and hydroxyapatite

et al. 2019

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Ultrahigh molecular weight polyethylene (UHMWPE) artificial joint has remained the preferred polymer component in total joint replacement surgery. However, more and more concerns have been raised about the failure of UHMWPE components due to the initiation and propagation of cracks at the notches with fixed functions. For this reason, biaxial fatigue crack growth (FCG) experiments of UHMWPE reinforced by carbon nanofibers (CNF) and hydroxyapatite (HA) were carried out using elastic–plastic fracture mechanics theory. The FCG resistance of UHMWPE, UHMWPE/CNF, and UHMWPE/HA was compared, and the effects of stress ratio (R) value and phase difference on FCG rate were investigated. At the same time, the influence of loading path was considered, and the corresponding crack path was analyzed. Results suggest that UHMWPE/CNF has better FCG resistance and the FCG rate increases with the increase of R value and the existence of 180° phase difference. In addition, crack bifurcation behavior is not observed under nonproportional loading conditions. The findings in this study will provide experimental validation and data support for better clinical application of UHMWPE‐modified materials.

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Catastrophic failure of an acetabular total hip arthroplasty component mimicking a posterior dislocation

Cited by 6 publications

References 18 publications

Catastrophic Wear of an Acetabular Component Misdiagnosed as Total Hip Arthroplasty Dislocation

Catastrophic Wear of an Acetabular Component Misdiagnosed as Total Hip Arthroplasty Dislocation

The Utility of a Plain Film Arthrogram to Confirm Acute Liner Dissociation in the Setting of Primary Total Hip Arthroplasty

Biaxial fatigue crack propagation behavior of ultrahigh molecular weight polyethylene reinforced by carbon nanofibers and hydroxyapatite

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