Case ReportFracture of a Cross-Linked Polyethylene Liner: A Multifactorial Issue
Section snippets
Case Report
A 71-year-old man with a body mass index of 43.2 (height, 68 in; weight, 284 lb) underwent bilateral hip hemiarthroplasties performed for osteoarthritis, on the right in 1984 and on the left in 1986. In 2001, he was referred and diagnosed with bilateral superior hemiarthroplasty migration (right Paprosky IIIA, left IIA/IIIA), with osseointegrated cementless femoral components. The patient underwent bilateral conversions to total hip arthroplasties performed at separate surgeries (right
Analysis of the Retrieved Liner
The fracture in the polyethylene followed a curved path between 2 notches on the external surface of the liner (Fig. 3). These notches were intended to provide access for placement of either push pins or screws into the acetabular shell to prevent rotation of the liner. The portion of the fragment that had been part of the face of the liner (Fig. 3, center left) was plastically deformed and polished; and the inner surface of the fragment also was polished, consistent with repetitive anterior
Discussion
The clinical performance to date of most 5-Mrad remelted polyethylene acetabular components has indicated that these design parameters represented an appropriate balance between the requirements of reducing wear and preserving strength. For example, in the 5-year minimum clinical follow-up by Leung and colleagues [6], the wear rate of 5-Mrad remelted polyethylene averaged about 95% lower than that of non–cross-linked polyethylene (ie, gas-plasma sterilized). Similarly, Bitsch and colleagues [17]
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Cited by (44)
Instability After Primary Total Hip Arthroplasty: Dual Mobility Versus Jumbo Femoral Heads
2022, Journal of ArthroplastyPairing 40-mm Femoral Heads With the Smallest Compatible Acetabular Components in Total Hip Arthroplasty: Mid-Term Outcomes in 177 Cases
2022, Journal of ArthroplastyCitation Excerpt :In this series of 177 primary THAs with 40-mm femoral heads and acetabular components ≤56 mm with HXLPE, there were no liner failures, cumulative incidence of dislocation was modest, and cumulative incidences of any revision or any reoperation were low at mid-term follow-up. Liner fracture or dissociation is a rare occurrence but theoretically at greatest risk in implant combinations utilizing the thinnest acetabular liners [7–9]. Despite acetabular liner rim thickness as thin as 3 mm in some implant systems included in this study, there were no instances of mechanical liner failures including fracture or dissociation.
Survivorship and Clinical Outcomes of Constrained Acetabular Liners in Primary and Revision Total Hip Arthroplasty: A Systematic Review
2021, Journal of ArthroplastyCitation Excerpt :Despite that, a significant reduction in dislocation rate after revision THA was noted with large diameter femoral heads (36 mm or 40 mm) compared with smaller ones (32 mm), 1.1% and 8.7% respectively [63]. However, large diameter femoral heads have raised multiple concerns regarding potential downsides including increased volumetric wear, increased stress within a thinner polyethylene liner and at the trunnion-head junction leading to potential mechanical failure, local tissue reactions related to fretting corrosion when large metal heads are used, and potential impingement with the iliopsoas tendon [64–69]. CALs are currently used in multiple settings, and the most common indications are recurrent dislocation, inadequate soft tissue envelop with abductor mechanism deficiency, and neuromuscular disorders.
Modern Dual-Mobility Cups in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis
2018, Journal of Arthroplasty
No benefits or funds were received in support of the study.
Investigation performed at the Sutter Medical Center, Sacramento, CA, and the J Vernon Luck Sr, MD, Orthopaedic Research Center, Los Angeles, CA.