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The Journal of Bone and Joint Surgery (American) 84:1587-1593 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Cementation of a Polyethylene Liner into a Metal Shell

Factors Related to Mechanical Stability

Kevin F. Bonner, MD, Ronald E. Delanois, MD, Greg Harbach, MD, Michael Bushelow and Michael A. Mont, MD

Investigation performed at the Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia

Kevin F. Bonner, MD
Jordan-Young Institute, 5501 Greenwich Road, Suite 200, Virginia Beach, VA 23462

Ronald E. Delanois, MD
Greg Harbach, MD
Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Charette Healthcare Center, 27 Effingham Street, Portsmouth, VA 23708

Michael Bushelow
359 Veterans Boulevard, Rutherford, NJ 07070-2584

Michael A. Mont, MD
2411 West Belvedere Avenue, Baltimore, MD 21215
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Various clinical situations may make polyethylene liner exchange desirable in the setting of a well-fixed metal shell. Options have included a simple polyethylene liner exchange or revision of the entire acetabular shell. A recently introduced technique involves cementation of a new liner into a well-fixed metal shell. The purposes of this study were to quantify the mechanical integrity of this method of liner fixation, to evaluate the factors that may influence immediate liner fixation, and to compare this construct with a standard locking mechanism.

Methods: One modular acetabular cup design was evaluated. Variables that may contribute to the mechanical integrity of the construct were evaluated via lever-out and multiaxis dislocation testing methods. The variables included the size of the liner (undersized versus oversized), type of liner (all-polyethylene versus modular design), modification of the modular liner (unmodified versus grooved), and groove configuration (cruciform versus circumferential). Metal shells with and without screw-holes were also tested. The modular locking mechanism was used as the control.

Results: None of the constructs failed at the cement-metal interface. All undersized liners required significantly higher loads to failure than either the controls (p < 0.001) or the oversized liners (p < 0.001). Oversized unmodified liners failed at significantly lower loads than the controls did (p < 0.01). The creation of circumferential grooves in the oversized liners significantly improved the strength of the constructs (p < 0.01), making them comparable with the controls. No significant differences were found among the four undersized groups (p > 0.3). The standard locking construct (control) and the oversized unmodified construct failed at a force of 2000 N in the multiaxis dislocation test. No other construct failed with use of this test mode.

Conclusions: Cementation of a polyethylene liner into a metal shell can be stronger than a conventional locking mechanism if the liner is undersized. Cementation of an oversized liner into a shell should be performed with caution. The long-term durability of this fixation remains unknown.

Clinical Relevance: Cementation of a polyethylene liner in a well-fixed metal shell may provide an alternative option in acetabular revision surgery.


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J. J. Callaghan, J. Parvizi, C. C. Novak, B. Bremner, W. Shrader, D. G. Lewallen, R. C. Johnston, and D. D. Goetz
A Constrained Liner Cemented into a Secure Cementless Acetabular Shell
J. Bone Joint Surg. Am., October 1, 2004; 86(10): 2206 - 2211.
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