Acetabular revision cementing a liner into a stable acetabular shell
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Published:
Dec 28, 2013
Keywords:
Fixed cup, Cementing, Polyethylene component
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Abstract
BackgroundModular liner component failure in fixed shells is an increasingly frequent scenario in prosthetic revision surgery. A complete acetabular revision is too aggressive when the metallic component can be saved. An alternative is to cement a liner within the fixed shell. We report our results using this technique, pointing out its indications, modus operandi and possible limitations.MethodsFrom 2001 to 2011, 40 polyethylene components were cemented within fixed shells. All patients were radiologically and clinically evaluated. The reasons for which a polyethylene component was cemented were: capture mechanism failure (11 cases, 27.5%), stability (18 cases, 45%) and liner unavailability (11 cases, 27.5%).ResultsThe survival rate without reoperation after 46 months of follow-up was 92%. One case (2.4%) developed an infection, and two cases evidenced instability (4.8%). The survival rate for aseptic loosening was 100%. The pre-operative Harris score was of 59, increasing up to 80 in the post-operatory period.ConclusionsTechnical data to be taken into account for success: use an undersized component, to cement textured components and to leave a uniform cement layer of at least 2 mm. Our preliminary results cementing a polyethylene component within a fixed shell would seem to justify this revision technique to prevent the loss of bone stock associated with cementless cup revision.
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Bidolegui, F. M., Pereira, S., Lugones, A., Pereira, H., & Vindver, G. (2013). Acetabular revision cementing a liner into a stable acetabular shell. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 78(4), 190-198. https://doi.org/10.15417/171
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Clinical Research
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References
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2. Haft DA, Heiner AD, Dorr LD, Brown TD, Callaghan JJ. A biomechanical analysis of polyethylene liner cementation into a fixed metal acetabular shell. J Bone Joint Surg Am 2003;85:1100-10.
3. Callaghan JJ, Parvizi J, Novak CC, Bremner B, Shrader W, Lewallen DG, et al. A constrained liner cemented into a secure cementless acetabular shell. J Bone Joint Surg Am 2004;86(10):2206-11.
4. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture. Treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am 969;51:737-54.
5. Claus AM, TottermanSM, Sychterz CJ, Tamez-pena JG, Looney RJ, Engh CA Sr. Computed tomography to assess pelvic lysis after total hip replacement. Clin Orthop 2004;422:167-74.
6. Jiranek WA. Acetabular liner fixation by cement. Clin Orthop Relat Res 2003;417:217-23.
7. Heiner AD, Haft GF, Dorr LD, Brown TD, Callaghan JJ. A biomechanical analysis of polyethylene liner cementation into a fixed metal acetabular shell. Trans Orthop Res Soc 2003;49:1367.
8. Beaule PE, Ebramzadeh E, LeDuff MA, Prasad R, Amstutz HC. Cementing a liner into a stable cementless acetabular shell: The double-socket technique. J Bone Joint Surg Am 2004;86(5):929-34.
9. Bonner KF, Delanois RE, Harbach G, Bushelow M, Mont MA. Cementation of a polyethylene liner into a metal shell: factors related to mechanical stability. J Bone Joint Surg Am 2002;84:1587-93.
10. Louwerse RT, Heyligers IC. Late failure of the polyethylene liner fixation in an uncemented total hip arthroplasty. J Arthroplasty 1999;14:391-6.
11. Meldrum RD, Hollis JM. The strenght of a cement acetabular locking mechanism. J Arthroplasty 2001;16:748-52.
12. Bensen CV, Del Schutte H Jr, Weaver KD. Mechanical stability of polyethylene liners cemented into acetabular shells. Crit Rev Biomed Eng 2000;28(1-2):7-10.
13. Ebramzadeh E, Beaule PE, Culwell JL, Amstutz H. Fixation strength of an all metal acetabular component cemented into an acetabular shell. A biomechanical analysis. J Arthroplasty 2004;19:45-9.
14. Dunlop D, Oxland T, Gordon J, Garbuz D, Masri B, Duncan C. The biomechanics of cementing a new liner into a well-fixed metal acetabular shell. Trans Orthop Res Soc 2002;27:973.
15. Oh I. A comprehensive analysis of the factors affecting acetabular cup fixation and design in total hip replacement arthroplasty: a series of experimental and clinical studies. The Hip Proceedings of the Eleventh Open Scientific Meeting of the Hip Society, St Louis: CV Mosby; 983:129-77.
16. Laporte DM, Mont MA, Pierre-Jacques H, Peyton RS, Hungerford DS. Technique for acetabular liner revision in nonmodular metal-backed component. J Arthroplasty 1998;13:348-50.
17. Bohm P, Bosche R. Survival analysis of the Harris Galante I acetabular cup. J Bone Joint Surg Br 1998;80:396-403.
18. Gonzalez della Valle A, Ruzo PS, Li S, Pellicci P, Sculco TP, Salvati EA. Dislodgment of polyethylene liners in first and second-generation Harris Galante acetabular components. A report of eightheen cases. J Bone Joint Surg Am 1997;83:553-9.
19. Peters CL, Dunn HK. The cementless acetabular component. En: Callaghan JJ, Rosenberg AG, Rubash HE (eds.). The Hip. Philadelphia: Lippincott-Raven; 1998:993-1016.
20. Silverton CD, Rosenberg AG, Sheinkop MB, Galante JO. Revision of the acetabular component without cement after total hip arthroplasty. A follow-up note regarding results at seven to eleven years. J Bone Joint Surg Am 1996;78:1336-70.
21. Maloney WJ, Herzwurm P, Paprosky W, Rubash HE, Engh CA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as a part of a total hip replacement. J Bone Joint Surg Am 1997;79:1628-34.
22. Schmalzried TP, Fowble VA, Amstutz HC. The fate of pelvis osteolysis after reoperation. No recurrence with lesional treatment. Clin Orthop 1998;350:128-37.
23. Niggemeyer O, Fink B, Ruther W. Dislocation of the polyethylene liner in hip arthroplasty: 6 patients with dislocation within 3 years. Acta Orthop Scand 2002;73:403-6.
24. Scott DL, Campbell PA, McClung CD, Schmalzried TP. Factors contributing to rapid wear and osteolysis in hips with modular acetabular bearings made of hylamer. J Arthroplasty 2000;15:35-46.
25. Weber KL, Callaghan JJ, Goetz DD, Johnston RC. Revision of a failed cemented total hip prosthesis with insertion of an acetabular component without cement and a femoral component with cement. A five to eight year follow-up study. J Bone Joint Surg Am 1996;78:982-94.
26. Heck DA, Murray DG. In vivo construction of a metal-backed, high molecular weight polyethylene cup during McFee-Farrar revision total joint arthroplasty. A case report. J Arthroplasty 1986;1:203-6.
27. Khanuja HS, Aggarwal A, Hungerford MC, Hungerford DS, Jones LC, Mont MA. Cementing polyethylene liners into nonmodular acetabular components in revision total hip arthroplasty. J Orthop Surg 2010;18(2):184-8.
28. Kummer FJ, Adams MC, Dicesare PE. Revision of polyethylene acetabular liners with a cemented polyethylene cup. A laboratory
study. J Arthroplasty 2002;17:1055-7.
29. Yoon TR, Seon JK, Song EK, Chung JY, Seo HY, Park YB. Cementation of a metal inlay polyethylene liner into a stable metal
shell in revision total hip arthroplasty. J Arthroplasty 2005;20:652-7.
30. Goetz DD, Capello WN, Callaghan JJ, Brown TD, Johnston RC. Salvage of total hip instability with a constrained acetabular component. J Bone Joint Surg 1998;80(4):502-9.
31. Desantis M, Dorr LD, Longjjohn DB, Wan Z. Can inserts be cemented into fixed shells at revision THR? Presented as a poster at the Annual Meeting of the American Academy of Orthopaedic Surgeons; 2000, Mar 15-19, Orlando, Florida.
32. Ranawat AS, DiGiovanni CW, Pellici PM. Treatment of recurrent instability after total hip arthroplasty by cementing constrained liners into well fixed, metal backed shells: Two years results. 67th Annual Meeting Proceedings. Rosemont IL, American Academy of Orthopeadic Surgeons, 2000:312.
33. Haft DA, Heiner AD, Callaghan JJ, Dorr LD, Wan Z, Long W, et al. Polyethylene liner cementation into fixed acetabular shells. J Arthroplasty 2002;17:167-70.
34. Callaghan JJ, Liu SS, Schularick NM. Shell retention with cemented acetabular liner. Orthopaedics 2009;32(9):673-75.
35. Hofmann AA, Prince EJ, Drake FT, Hunt KJ. Cementation of a polyethylene liner into a metal acetabular shell: a biomechanical study. J Arthroplasty 2009;24(5):775-82.
36. Mahuerman DR, Peindl RD, Coley ER, Marshall A. Cementation of polyethylene liners into well-fixed metal shells at the time of revisión total hip arthroplasty. J Arthroplasty 2008;23(6):873-8.
2. Haft DA, Heiner AD, Dorr LD, Brown TD, Callaghan JJ. A biomechanical analysis of polyethylene liner cementation into a fixed metal acetabular shell. J Bone Joint Surg Am 2003;85:1100-10.
3. Callaghan JJ, Parvizi J, Novak CC, Bremner B, Shrader W, Lewallen DG, et al. A constrained liner cemented into a secure cementless acetabular shell. J Bone Joint Surg Am 2004;86(10):2206-11.
4. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture. Treatment by mold arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am 969;51:737-54.
5. Claus AM, TottermanSM, Sychterz CJ, Tamez-pena JG, Looney RJ, Engh CA Sr. Computed tomography to assess pelvic lysis after total hip replacement. Clin Orthop 2004;422:167-74.
6. Jiranek WA. Acetabular liner fixation by cement. Clin Orthop Relat Res 2003;417:217-23.
7. Heiner AD, Haft GF, Dorr LD, Brown TD, Callaghan JJ. A biomechanical analysis of polyethylene liner cementation into a fixed metal acetabular shell. Trans Orthop Res Soc 2003;49:1367.
8. Beaule PE, Ebramzadeh E, LeDuff MA, Prasad R, Amstutz HC. Cementing a liner into a stable cementless acetabular shell: The double-socket technique. J Bone Joint Surg Am 2004;86(5):929-34.
9. Bonner KF, Delanois RE, Harbach G, Bushelow M, Mont MA. Cementation of a polyethylene liner into a metal shell: factors related to mechanical stability. J Bone Joint Surg Am 2002;84:1587-93.
10. Louwerse RT, Heyligers IC. Late failure of the polyethylene liner fixation in an uncemented total hip arthroplasty. J Arthroplasty 1999;14:391-6.
11. Meldrum RD, Hollis JM. The strenght of a cement acetabular locking mechanism. J Arthroplasty 2001;16:748-52.
12. Bensen CV, Del Schutte H Jr, Weaver KD. Mechanical stability of polyethylene liners cemented into acetabular shells. Crit Rev Biomed Eng 2000;28(1-2):7-10.
13. Ebramzadeh E, Beaule PE, Culwell JL, Amstutz H. Fixation strength of an all metal acetabular component cemented into an acetabular shell. A biomechanical analysis. J Arthroplasty 2004;19:45-9.
14. Dunlop D, Oxland T, Gordon J, Garbuz D, Masri B, Duncan C. The biomechanics of cementing a new liner into a well-fixed metal acetabular shell. Trans Orthop Res Soc 2002;27:973.
15. Oh I. A comprehensive analysis of the factors affecting acetabular cup fixation and design in total hip replacement arthroplasty: a series of experimental and clinical studies. The Hip Proceedings of the Eleventh Open Scientific Meeting of the Hip Society, St Louis: CV Mosby; 983:129-77.
16. Laporte DM, Mont MA, Pierre-Jacques H, Peyton RS, Hungerford DS. Technique for acetabular liner revision in nonmodular metal-backed component. J Arthroplasty 1998;13:348-50.
17. Bohm P, Bosche R. Survival analysis of the Harris Galante I acetabular cup. J Bone Joint Surg Br 1998;80:396-403.
18. Gonzalez della Valle A, Ruzo PS, Li S, Pellicci P, Sculco TP, Salvati EA. Dislodgment of polyethylene liners in first and second-generation Harris Galante acetabular components. A report of eightheen cases. J Bone Joint Surg Am 1997;83:553-9.
19. Peters CL, Dunn HK. The cementless acetabular component. En: Callaghan JJ, Rosenberg AG, Rubash HE (eds.). The Hip. Philadelphia: Lippincott-Raven; 1998:993-1016.
20. Silverton CD, Rosenberg AG, Sheinkop MB, Galante JO. Revision of the acetabular component without cement after total hip arthroplasty. A follow-up note regarding results at seven to eleven years. J Bone Joint Surg Am 1996;78:1336-70.
21. Maloney WJ, Herzwurm P, Paprosky W, Rubash HE, Engh CA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as a part of a total hip replacement. J Bone Joint Surg Am 1997;79:1628-34.
22. Schmalzried TP, Fowble VA, Amstutz HC. The fate of pelvis osteolysis after reoperation. No recurrence with lesional treatment. Clin Orthop 1998;350:128-37.
23. Niggemeyer O, Fink B, Ruther W. Dislocation of the polyethylene liner in hip arthroplasty: 6 patients with dislocation within 3 years. Acta Orthop Scand 2002;73:403-6.
24. Scott DL, Campbell PA, McClung CD, Schmalzried TP. Factors contributing to rapid wear and osteolysis in hips with modular acetabular bearings made of hylamer. J Arthroplasty 2000;15:35-46.
25. Weber KL, Callaghan JJ, Goetz DD, Johnston RC. Revision of a failed cemented total hip prosthesis with insertion of an acetabular component without cement and a femoral component with cement. A five to eight year follow-up study. J Bone Joint Surg Am 1996;78:982-94.
26. Heck DA, Murray DG. In vivo construction of a metal-backed, high molecular weight polyethylene cup during McFee-Farrar revision total joint arthroplasty. A case report. J Arthroplasty 1986;1:203-6.
27. Khanuja HS, Aggarwal A, Hungerford MC, Hungerford DS, Jones LC, Mont MA. Cementing polyethylene liners into nonmodular acetabular components in revision total hip arthroplasty. J Orthop Surg 2010;18(2):184-8.
28. Kummer FJ, Adams MC, Dicesare PE. Revision of polyethylene acetabular liners with a cemented polyethylene cup. A laboratory
study. J Arthroplasty 2002;17:1055-7.
29. Yoon TR, Seon JK, Song EK, Chung JY, Seo HY, Park YB. Cementation of a metal inlay polyethylene liner into a stable metal
shell in revision total hip arthroplasty. J Arthroplasty 2005;20:652-7.
30. Goetz DD, Capello WN, Callaghan JJ, Brown TD, Johnston RC. Salvage of total hip instability with a constrained acetabular component. J Bone Joint Surg 1998;80(4):502-9.
31. Desantis M, Dorr LD, Longjjohn DB, Wan Z. Can inserts be cemented into fixed shells at revision THR? Presented as a poster at the Annual Meeting of the American Academy of Orthopaedic Surgeons; 2000, Mar 15-19, Orlando, Florida.
32. Ranawat AS, DiGiovanni CW, Pellici PM. Treatment of recurrent instability after total hip arthroplasty by cementing constrained liners into well fixed, metal backed shells: Two years results. 67th Annual Meeting Proceedings. Rosemont IL, American Academy of Orthopeadic Surgeons, 2000:312.
33. Haft DA, Heiner AD, Callaghan JJ, Dorr LD, Wan Z, Long W, et al. Polyethylene liner cementation into fixed acetabular shells. J Arthroplasty 2002;17:167-70.
34. Callaghan JJ, Liu SS, Schularick NM. Shell retention with cemented acetabular liner. Orthopaedics 2009;32(9):673-75.
35. Hofmann AA, Prince EJ, Drake FT, Hunt KJ. Cementation of a polyethylene liner into a metal acetabular shell: a biomechanical study. J Arthroplasty 2009;24(5):775-82.
36. Mahuerman DR, Peindl RD, Coley ER, Marshall A. Cementation of polyethylene liners into well-fixed metal shells at the time of revisión total hip arthroplasty. J Arthroplasty 2008;23(6):873-8.