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

R Bidar1, J Girard, O May

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Isolated acetabular polyethylene exchange in total hip arthroplasty (THA) offers shorter operative times but carries risks. Liner replacement alone is insufficient for acetabular osteolysis, necessitating careful patient selection and alignment.

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science

Background:

  • Metal-backed cups in total hip arthroplasty (THA) allow for isolated acetabular polyethylene liner exchange.
  • This approach is theorized to reduce operative time and preserve acetabular bone stock.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of isolated acetabular polyethylene liner exchange compared to more extensive acetabular component revision.

Main Methods:

  • Retrospective analysis of 68 THA revisions involving polyethylene liner replacement (alone or with femoral component revision).
  • Comparison with a matched control group undergoing acetabular and femoral component revision.
  • Posterolateral surgical approach used in all cases.

Main Results:

  • Liner replacement alone significantly reduced operative time and hospital stay.
  • Osteolysis was present in 19 hips pre-revision; new or aggravated osteolysis occurred in 7 hips post-revision.
  • Dislocations occurred in 9 hips (7 posterior), more frequently with cup inclination <40 degrees and in patients with prior hip surgeries.
  • Seven-year survival rates were comparable across liner replacement alone, combined liner/femoral revision, and full acetabular/femoral revision (82-84%).

Conclusions:

  • Isolated liner exchange can decrease morbidity but is inadequate for acetabular osteolysis, which may require debridement with grafting or complete revision.
  • While survival rates are comparable to complex revisions, risks of dislocation and liner dislodgement are significant.
  • This procedure is recommended only for well-aligned cups, secure liner seating, and not in patients with multiple prior hip operations.