[Polyethylene liner replacement: behavior and morbidity in 68 cases]

R Bidar, J Girard, O May, Y Pinoit, P Laffargue, H Migaud
Revue de Chirurgie Orthopédique et Réparatrice de L'appareil Moteur 2007, 93 (5): 461-8

PURPOSE OF THE STUDY: Isolated acetabular polyethylene exchange is advocated as an advantage of metal-backed cups, since the acetabular bone stock can be spared and operative time is shorter. The purpose of this study was to determine whether this is true.

MATERIAL AND METHODS: A consecutive serie of 68 THA revisions involving replacement of the polyethylene liner was analyzed retrospectively (liner replacement alone for 37 hips and liner replacement plus femoral component revision for 31). The posterolateral approach was used for the revision in all cases. This series was compared with a control series of revisions involving the acetabular component with revision of the femoral component in patients matched for age, sex, and BMI.

RESULTS: Operative time and hospital stay were significantly shorter when the revision involved the polyethylene liner alone. In 19 hips, a limited zone of osteolysis was observed around the liner before replacement. At last follow-up, new zones of osteolysis were noted in two hips and aggravation in five, one of which required revision because of acetabular loosening. Episodes of dislocation were observed in nine hips (2 anterior and 7 posterior) of which three underwent revision because of recurrence. These dislocations occurred after liner replacement (n=4) or combined liner and femoral component replacement (n=5). Dislocations were more frequent after multiple hip operations and when the cup inclination was less than 40 degrees . Ten revisions were required for: an unclipped liner (n=2), recurrent dislocation (n=3), acetabular loosening (n=1), infection which was cured after a one-stage procedure (n=1). At seven years, survival was comparable between liner replacement alone (82+/-10%), combined liner replacement and femoral component revision (84+/-11%), and femoral component and acetabular component revision (82+/-11%).

DISCUSSION: Changing the cup liner can limit morbidity compared with a more complex revision, but liner replacement alone is insufficient in the event of acetabular osteolysis. It would be preferable to combine osteolysis debridement with a graft or a complete revision. The survival rate after liner replacement is comparable with that observed after more complex revision but the risks of dislocation or unclipped insert are significant. For this reason, liner replacement alone should only be proposed if the cup is correctly aligned and if the new liner can be solidly clipped into the metal back. In addition, this simplified procedure should not be attempted after multiple hip operations.

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