Failure of constrained acetabular liner without metal ring disruption

Constrained acetabular liners can fail leading to recurrent dislocation. Failure can occur at any of the five possible interfaces: bone-acetabular shell, acetabular shell-constrained liner insert, constrained liner insert-bipolar head, bipolar head- femoral head and femoral head-trunion. We report a patient who presented with dissociation of the cemented Osteonics acetabular constrained liner (Stryker-Howmedica-Osteonics, Rutherford, New Jersey). The failure interface was at the factory pre-assembled constrained liner insert-bipolar head without any locking ring failure; instead there was deformation of the constrained liner insert's polyethylene rim, which facilitated dissociation. To our knowledge, there are no previous reports of such a failure mode pertaining to this type of constrained liner. Constrained acetabular liners are indicated during primary or revision total hip arthroplasty for patients who are at high risk for dislocations or who have had recurrent dislocations. Failure rates (typically recurrent dislocation) range from 4% to 29% at mid-term follow-up. The first report on the Osteonics acetabular constrained liner was published in 1994. Failures have been reported previously to occur at surgically controllable interfaces, such as the acetabular shell from the bony surface and the constrained liner insert from the acetabular metal shell, and have been attributable to excessive constraint or improper technique. All dissociations pertaining to factory-preassembled component interfaces have been attributed to breakage of the locking ring. This article presents the first case of disengagement of the tripolar constrained liner without disruption of the locking ring.