Cementation of new liners into a well-fixed acetabular frame
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The cementation of a new liner into a well-fixed acetabular component is common during revision total hip arthroplasty (THA) for many indications, but most commonly for lack of a modern, compatible, highly cross-linked polyethylene (HXLPE) liner. The purpose of this study was to evaluate the implant survivorship, risk of complications, clinical outcomes, and radiographic results of cementing a new HXLPE liner into a well-fixed acetabular component.

Researchers retrospectively identified 323 revision THAs in which a nonconstrained HXLPE liner was cemented into a well-fixed acetabular component. The mean age at the time of the revision THA was 63 years, and 50% of patients were female. The most common indications for revision THA were polyethylene wear and osteolysis (48%), aseptic femoral loosening (35%), and hip instability (8%). The mean follow-up was 9 years.

Results:
--Polyethylene liner failure occurred in 11 cases (3%). In all cases, the cemented liner dissociated from the acetabular component.

--At 10 years, the survivorship free from any revision was 80% and the survivorship free from any reoperation was 77%.

--The most common reason for re-revision was dislocation (45% of reoperations). A dislocation occurred in 17% of cases.

--Hips that underwent revision for instability were significantly more likely to dislocate compared with hips that underwent revision for liner wear (hazard ratio [HR], 2.3).

--Elevated rim or face-changing liners were significantly more likely to dissociate than flat liners (HR, 9.0).

Conclusively, during THA revision, cementation of a non-constrained HXLPE liner into a well-fixed acetabular part produced durable fixation with only a small number of cement interface failures (3% ). Instability remains a problem after this treatment, but this is of a multifactorial nature. These data support the continued use, if necessary, of this technique during THA revision.

Source: https://journals.lww.com/jbjsjournal/subjects/hip/Abstract/2020/08190/Intermediate_to_Long_Term_Follow_up_of_Cementing.5.aspx
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