Cementing a liner into a stable cementless acetabular shell: the double-socket technique

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Revision Arthroplasty

Background:

• Revision hip replacement often presents challenges with well-fixed cementless acetabular shells and ineffective locking mechanisms.
• The double-socket technique, involving cementing a new liner into an existing shell, provides a potential solution.
• This study evaluates the clinical outcomes and limitations of the double-socket technique.

Purpose of the Study:

• To review initial clinical results of the double-socket technique in revision hip replacement.
• To define the potential limitations and identify suitable candidates for this procedure.

Main Methods:

• Thirty-two hips with well-fixed acetabular sockets (average 8.6 years in situ) underwent cement insertion of a new liner (polyethylene or metal).
• Indications included deficient locking mechanisms (22 hips) or unavailable matching liners (10 hips).
• Radiographic analysis was performed by an independent reviewer.

Main Results:

• Mean follow-up was 5.1 years, with 6 reoperations (aseptic failure, instability, sepsis).
• Significant improvement in University of California at Los Angeles hip scores for pain, walking, function, and activity.
• A 22% dislocation rate and a 5-year survival rate of 78% were observed.

Conclusions:

• The double-socket technique is a suitable alternative to acetabular shell removal in select patients with well-fixed sockets.
• This bone-preserving method allows for conversion to alternate bearing surfaces.
• For patients with instability, acetabular shell removal or constrained liners should be strongly considered.