Related Experiment Video
Updated: Mar 31, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Minimum 10-year Results of Cementing a Polyethylene Liner Into an Acetabular Cup With a Deficient Locking Mechanism:
Kee Hyung Rhyu1, Yoon Je Cho1, Young Soo Chun2
1Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Republic of Korea.
Background:
Cementing a new liner into a well-fixed acetabular cup with a deficient locking mechanism has been reported as a viable option, but concerns remain regarding complications such as dislocation and late loosening.
Questions/Purposes:
What were the (1) durability of the cement-liner interface, (2) patient-reported outcome scores and complications, and (3) survivorship free from revision after liner cementation into a single acetabular cup design (Harris-Galante II, Zimmer) when the cup's locking mechanism was found to be deficient?
Methods:
Between May 2006 and January 2015, two surgeons performed 76 revision procedures with retention of the metallic shell by cementing a new polyethylene liner into the existing shell. During that time, this procedure was used when the acetabular shell was well fixed but the locking mechanism was found to be deficient, or when a compatible liner was unavailable. When the native locking mechanism appeared intact, liner exchange was performed using the original locking mechanism without cementation. All patients treated with this procedure were considered potentially eligible for inclusion in this retrospective study. Of those, 9% (7 of 76) were excluded because they had a shell other than the Harris-Galante II cup, which was the focus of this study. An additional 16% (12 of 76) were lost prior to the minimum study follow-up of 10 years or had incomplete data sets, leaving 75% (57 of 76) for analysis. In patients who underwent bilateral procedures, the hip operated on first was selected for analysis to avoid nonindependence of observations, resulting in a final cohort of 51 patients. A highly crosslinked polyethylene liner was used in all procedures. The mean ± SD patient age at revision surgery was 57 ± 12 years, and the median (range) follow-up was 14 years (10 to 18), with all patients having a minimum 10-year follow-up. Fifty-one percent (26 of 51) of the patients were men. Clinical outcomes and complications were assessed using medical records and radiographs. Implant survivorship was estimated using the Kaplan-Meier method at 10 and 15 years with 95% confidence intervals (CIs), using acetabular cup revision as the endpoint.
Results:
The cement-liner interface remained intact throughout follow-up. The mean ± SD Harris hip score improved from 74 ± 21 to 88 ± 11 (p < 0.001), and the WOMAC score also improved from 79 ± 13 to 59 ± 14 (p < 0.001), whereas both the SF-12 mental and physical component summary scores did not improve. Complications occurred in 39% (20 of 51) of patients, including posterior dislocation, late cup loosening, new osteolysis, and periprosthetic femoral fracture. Kaplan-Meier survivorship free from acetabular cup revision was 88% (95% CI 80% to 98%) at 10 years and 77% (95% CI 66% to 90%) at 15 years.
Conclusion:
The results of this study suggest that liner cementation into Harris-Galante II shells (Zimmer) resulted in frequent complications and lower survivorship than we expected, and given that 16% (12 of 76) of the patients were lost to follow-up, our findings may have underestimated the risk of complications. Therefore, surgeons should exercise caution when considering isolated liner cementation, particularly given the high rates of dislocation and late shell loosening, and patients should be counseled thoroughly regarding these risks.
Level Of Evidence:
Level IV, therapeutic study.
