The Journal of Bone and Joint Surgery 83:553 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Dislodgment of Polyethylene Liners in First and Second-Generation Harris-Galante Acetabular Components
A Report of Eighteen Cases
Alejandro González DellaValle, MD,
Patricio Salonia Ruzo, MD,
Stephen Li, PhD,
Paul Pellicci, MD,
Thomas P. Sculco, MD and
Eduardo A. Salvati, MD
Investigation performed at The Hospital for Special Surgery,
New York City
Alejandro González Della Valle, MD
Department of Orthopedics, Hospital Italiano de Buenos Aires, Potosí 4215,
Buenos Aires C1199ACK, Argentina. E-mail address: agdv{at}bigfoot.com
Patricio Salonia Ruzo, MD
Department of Orthsopedics, Hospital Militar Central de Buenos Aires,
11 de Septiembre 1301, Buenos Aires 1426, Argentina. E-mail
address: patricio@bigfoot.com
Stephen Li, PhD
Paul Pellicci, MD
Thomas P. Sculco, MD
Eduardo A. Salvati, MD
Departments of Biomechanics (S.L.) and Orthopedic Surgery (P.P.,
T.P.S., and E.A.S.), The Hospital for Special Surgery, 535 East
70th Street, New York, NY 10021. E-mail address for S. Li: lis@hss.edu.
E-mail address for P. Pellicci: pelliccip@hss.edu.
E-mail address for T.P. Sculco: sculcot@hss.edu.
E-mail address for E.A. Salvati: salvatie@hss.edu
One or more of the authors has received or will receive benefits
for personal or professional use from a commercial party related
directly or indirectly to the subject of this article. In addition,
benefits have been or will be directed to a research fund, foundation,
educational institution, or other nonprofit organization with which
one or more of the authors is associated. Funds were received in total
or partial support of the research or clinical study presented in
this article. The funding sources were the Mr. Lawrence M. Gelb
Foundation and The Fanwood Foundation.
Background:
Dislodgment of the polyethylene liner is an increasingly common
complication following total hip arthroplasty. The purposes of this
study are to present the results in a series of patients with this complication
and to analyze the mode of failure.
Methods:
Between November 1995 and January 2001, eighteen patients who
had had a total hip arthroplasty presented with dislodgment of the
polyethylene liner from a Harris-Galante metal acetabular shell. The
medical records, radiographs, operative notes, and retrieved components
were reviewed. In addition, scanning electron microscopy was used
to study the fractured surfaces in a shell that had four broken
tines.
Results:
The components had been in situ for an average
of seven years (range, three to eleven years). Seventeen components
were second generation, and one was first generation. Symptoms developed
spontaneously in sixteen patients, during sexual intercourse in
one, and following a fall on the hip in one. Radiographs showed
eccentric positioning of the head in all of the hips and broken tines
in six. All of the shells were well fixed. Treatment consisted of
revision of the shell in four patients, exchange of the liner in
four, cementation of a new liner into the shell in seven, and cementation
of an all-polyethylene cup in three. The liners had severe damage
of the rim. Scanning-electron microscopy of the fractured surfaces
of four tines revealed a fatigue pattern.
Conclusions:
We believe that, as the liner wears and becomes loose because
of an inadequate locking mechanism, progressive micromotion occurs
and the load increases on the polyethylene rim until it deforms and/or
fractures. Subsequently, nothing prevents the liner from rotating
out of the shell. As this mechanism of failure appears to include
fatigue failure of the locking tines and wear of the liner, this
complication is likely to increase as the components age in
situ.
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