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Updated: Oct 14, 2025
PLGA Nanoparticles Formed by Single- or Double-emulsion with Vitamin E-TPGS
Published on: December 27, 2013
Early unexpected failure of a vitamin E-infused highly cross-linked polyethylene liner: A case report
Kyeong Baek Kim1, Sang-Min Lee1,2, Nam Hoon Moon2,3
1Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Rationale:
Total hip arthroplasty (THA) with a polyethylene (PE) liner is 1 of the most effective and successful treatment strategies for end-stage hip disorders. Vitamin E-infused highly cross-linked polyethylene is theoretically known to prevent failure due to oxidative degradation in the body, and is resistant to wear; therefore, successful long-term survival of THA is expected.
Patient Concerns:
In June 2019, approximately 1.5 years after THA, the patient sat down and stood up without any specific issue; however, an unusual bullet sound occurred around the left hip joint. Since then, his discomfort persisted, and he was admitted to the emergency department.
Diagnosis:
Plain radiography and metal artifact reduction computed tomography performed in the emergency department revealed eccentric elevation of the prosthetic femoral head and suspected PE liner failure.
Intervention:
Revision surgery was performed for modular component exchange. To reduce the dislocation risk without performing cup exchange, conversion to dual-mobility articulation was performed.
Outcomes:
During the regular follow-up post-surgery, the patient could perform daily life activities without any discomfort, and dislocation was not observed. At 2 years postoperatively, no significant changes were observed in the radiographic images.
Lessons:
This case report presents an unexpected failure of THA due to superior rim fracture and excessive wear at the locking mechanism of the vitamin E-infused highly cross-linked polyethylene liner. This is an interesting case, as early PE liner failure occurred without strong labor intensity or trauma. A modular component exchange was performed with a dual-mobility bearing, and no issues were observed approximately 2 years after the reoperation. Therefore, third-generation highly cross-linked polyethylene liners can also cause early failure without a clear cause, and this case report highlights the necessity of considering several strategies for reoperation.
Study Design:
Case report.
