Revision of an acetabular liner has a high risk of dislocation

Abstract

Polyethylene liners of modular acetabular components wear sometimes need to be replaced, despite the metal shell being well fixed. Replacing the liner is a relatively simple procedure, but very little is known of the outcome of revision. We prospectively followed up 1126 Harris-Galante I metal-backed, uncemented components for between nine and 19 years. We found 38 (3.4%) liners of 1126 acetabular components wore and required revision. These revisions were then followed up for a mean of 4.8 years. The rate of dislocation was 28.9%. Nine of the dislocations occurred once and two were recurrent. The overall secondary revision rate was three of 38 total hip replacements (7.9%) at a mean follow-up of 4.8 years. This gives a 92.1% survivorship (35 of 38) at under five years. In isolated revision of a liner, we had a complication rate of 23% (three of 13). In revision of a liner combined with revision of the femoral stem, there was a complication rate of 48% (12 of 25). We discuss possible reasons for the high dislocation rates. Leaving the well-fixed acetabular shell in situ leads to an increased risk of instability. However, this needs to be balanced against the otherwise low complication rate for revision of the liner. Patients should be consented accordingly.

The Surgical Options and Clinical Evidence for Treatment of Wear or Corrosion Occurring With THA or TKA

“…Nine articles remained after 460 were screened. One additional article was identified during the review of the bibliographies from the nine articles, resulting in a total of 10 articles for this topic [5,6,19,21,25,31,36,39,40,45] (Fig. 1).…”

“…The most frequently reported procedures for treating hip polyethylene wear with or without osteolysis were cup revision and isolated polyethylene exchange (Table 1) [5,6,19,21,25,31,36,39,40,45]. The mean followup in these articles ranged from 2.5 to 4.8 years.…”

“…Recurrent dislocation was also reported as a failure mode in two articles [5,40]. Only one of those reported the timing, which was 2.7 years after the initial revision [40].…”

“…Six articles reported recurrent dislocation rerevision rates from 0% to 8% [5,6,19,21,25,31]. Two of the articles reported a time frame for these rerevisions of 2.3 to 6.5 years [6,21].…”

“…Two of the articles reported a time frame for these rerevisions of 2.3 to 6.5 years [6,21]. Seven articles reported rerevisions for aseptic cup loosening after the initial polyethylene exchange was done, with rates ranging from 0% to 8% [5,6,19,21,31,36,39]. Four of the articles mentioned the timing of the rerevisions, which ranged from 2.3 to 6.5 years after the initial polyethylene exchange [6,21,36,39].…”