Clin Orthop Surg.  2019 Sep;11(3):270-274. 10.4055/cios.2019.11.3.270.

Isolated Acetabular Liner Exchange for Polyethylene Wear and Osteolysis with Well-Fixed Metal Shell

• Kim KW
• Yoo JJ
• Kim MN
• Kim HJ

• KMID: 2462554
• DOI: http://doi.org/10.4055/cios.2019.11.3.270

Abstract

BACKGROUND
The isolated liner and head exchange procedure has been an established treatment method for polyethylene wear and osteolysis when the acetabular component remains well fixed. In this study, the mid-term results of this procedure were evaluated retrospectively.
METHODS
Among the consecutive patients operated on from September 1995, two patients (three hips) were excluded because of inadequate follow-up, and the results of remaining 34 patients (34 hips) were evaluated. There were 20 men and 14 women with a mean age of 49 years. A conventional polyethylene liner was used in 26 cases and a highly cross-linked polyethylene liner was used in eight cases. In three cases, the liner was cemented in a metal shell because a compatible liner could not be used.
RESULTS
After a follow-up of 5 to 20.2 years, re-revision surgery was necessary in 10 cases (29.4%): in eight for wear and osteolysis at 55 to 101 months after liner exchange and in two for acetabular loosening at 1 and 1.5 years after liner exchange. Re-revision surgery included all component revision (four cases), cup revision (four cases), and liner exchange (two cases). In all re-revision cases, a conventional polyethylene liner was used initially. There was no failure in the cases in which a highly cross-linked polyethylene liner was used.
CONCLUSIONS
The results of this study suggest that isolated acetabular liner exchange is a reasonable option for wear and osteolysis when the metal shell is well fixed. More promising long-term results are expected with the use of highly cross-linked polyethylene liners.

Keyword

Humerus; Fracture fixation; Bone screws

MeSH Terms

Acetabulum*
Bone Screws
Female
Follow-Up Studies
Fracture Fixation
Head
Humans
Humerus
Male
Methods
Osteolysis*
Polyethylene*
Retrospective Studies
Polyethylene

Figure

• 

  Fig. 1 A female patient who underwent total hip arthroplasty at the age of 32 years. (A) The anteroposterior radiograph taken at the 7-year follow-up demonstrates polyethylene wear and osteolysis. (B) The liner and head were exchanged. (C) At the 6.5-year follow-up after the liner and head exchange, the radiograph shows the worn-out polyethylene liner and osteolysis. (D) Anteroposterior radiograph taken at 4 years after re-revision surgery for liner and head exchange. Postop: postoperative.

• 

  Fig. 2 A female patient who underwent total hip arthroplasty at the age of 31 years. (A) The radiograph taken at the 5-year follow-up shows polyehtylene wear and large osteolytic area. (B) Radiograph taken after liner and head exchange with bone graft. (C) At the 1-year follow-up after the liner and head exchange, the radiograph shows changes in cup position. (D) Anteroposterior radiograph taken after all component revision. Postop: postoperative.

• 

  Fig. 3 Photograph of conventional curettes bent in various fashion.

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