Abstract
Objective
To describe the imaging findings of polyethylene liner dissociation in total hip arthroplasty.
Materials and methods
Retrospective search of our institution’s radiology database identified 12 patients with polyethylene liner dissociation of a total hip arthroplasty. Clinical and operative notes were reviewed. All radiological studies were reviewed independently by two radiologists.
Results
Among 12 patients (seven females/five males; mean age: 67 years; median interval after surgery at diagnosis: 8.5 months) with polyethylene liner dissociation, 11 had radiographs, six had CT, seven had MRI, and two had arthrography. “Bubble sign” and “crescent sign” on radiography were insensitive, seen only in three patients, but all showed abrupt eccentric positioning of the femoral head. CT identified the dislocated liner in five of six patients but failed to identify one liner, which was partially associated with the acetabular cup. MRI identified the dislocated liner in all seven patients, with the MAVRIC (multiacquisition variable resonance image combination) sequences either increasing the diagnostic confidence relative to the routine pulse sequences or being the sole sequences in which the liner can be identified if the liner remained partially associated with the acetabular cup. Arthrography identified the dislocated liner in one of two patients.
Conclusions
Previously described radiographic signs of polyethylene liner dissociation are insensitive, but abrupt eccentric positioning of the femoral head in the correct clinical context is highly suggestive of the diagnosis. MRI and CT can accurately localize the displaced liner. MAVRIC is particularly helpful if the dislocated liner remains partially associated with the acetabular cup.
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References
White SP, Blom AW, Lee M, Smith EJ. The crescent sign: dissociation of the polyethylene liner from a modular acetabular component in total hip arthroplasty. Skelet Radiol. 2005;34:620–4.
Star MJ, Colwell CW Jr, Donaldson WF 3rd, Walker RH. Dissociation of modular hip arthroplasty components after dislocation. A report of three cases at differing dissociation levels. Clin Orthop Relat Res. 1992;278:111–5.
De Martino I, Triantafyllopoulos GK, Sculco PK, Sculco TP. Dual-mobility cups in total hip arthroplasty. World J Orthop. 2014;5:180–7.
Banka TR, Ast MP, Parks ML. Early intraprosthetic dislocation in a revision dual-mobility hip prosthesis. Orthopedics. 2014;37:e395–7.
Fehring KA, Berry DJ. Dissociation and intrapelvic entrapment of a dual-mobility polyethylene component. Clin Orthop Relat Res. 2016;474:1072–6.
Jang JH, Jin W, Chun YS, et al. The tram track sign: a characteristic sonographic feature of polyethylene liner dissociation after total-hip arthroplasty. J Ultrasound Med. 2014;33:1931–7.
Waddell BS, De Martino I, Sculco T, Sculco P. Total hip arthroplasty dislocations are more complex than they appear: a case report of intraprosthetic dislocation of an anatomic dual-mobility implant after closed reduction. Ochsner J. 2016;16:185–90.
Tyagi V, Akinbo O. Early intraprosthetic dislocation of a dual-mobility acetabular construct after total hip arthroplasty. J Orthop Case Rep. 2017;7:21–4.
Chauhan A, Fitzpatrick S, Sciulli RL, Sotereanos NG, Sewecke JJ. Using double-contrast CT arthrography to confirm suspected dissociation of a cemented polyethylene liner in the setting of revision total hip arthroplasty: a case report. JBJS Case Connect. 2017;7:e34.
Rhyu KH, Bae CI, Nam JH, Bae JG, Cho YJ, Chun YS. Dissociation of polyethylene liner of the dual-mobility acetabular component after closed reduction of dislocation: a case report. Hip Pelvis. 2017;29:133–8.
Fritz J, Lurie B, Miller TT, Potter HG. MR imaging of hip arthroplasty implants. Radiographics. 2014;34:E106–32.
Hayter CL, Koff MF, Potter HG. Magnetic resonance imaging of the postoperative hip. J Magn Reson Imaging. 2012;35:1013–25.
Langlois J, El Hage S, Hamadouche M. Intraprosthetic dislocation: a potentially serious complication of dual-mobility acetabular cups. Skelet Radiol. 2014;43:1013–6.
Suh KT, Chang JW, Suh YH, Yoo CI. Catastrophic progression of the disassembly of a modular acetabular component. J Arthroplast. 1998;13:950–2.
Su EP, Callander PW, Salvati EA. The bubble sign: a new radiographic sign in total hip arthroplasty. J Arthroplast. 2003;18:110–2.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.
Talbot BS, Weinberg EP. MR imaging with metal-suppression sequences for evaluation of total joint arthroplasty. Radiographics. 2016;36:209–25.
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Endo, Y., Geannette, C. & Chang, W.T. Imaging evaluation of polyethylene liner dissociation in total hip arthroplasty. Skeletal Radiol 48, 1933–1939 (2019). https://doi.org/10.1007/s00256-019-03232-x
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DOI: https://doi.org/10.1007/s00256-019-03232-x