Clinical Orthopaedics and Related Research

, Volume 467, Issue 1, pp 194–198 | Cite as

Isolated Polyethylene Exchange versus Acetabular Revision for Polyethylene Wear

  • Camilo Restrepo
  • Elie Ghanem
  • Carrie Houssock
  • Mathew Austin
  • Javad Parvizi
  • William J. Hozack
Symposium: Papers Presented at the Hip Society Meetings 2008


Polyethylene wear and osteolysis are not uncommon in THA mid- and long-term. In asymptomatic patients the dilemma faced by the orthopaedic surgeon is whether to revise the cup and risk damage to the supporting columns and even pelvic discontinuity or to perform isolated polyethylene exchange and risk a high rate of postoperative recurrent instability and dislocation that will necessitate further surgery. We retrospectively reviewed 62 patients (67 hips) who underwent revision arthroplasty for polywear and osteolysis. Thirty-six hips had isolated polyethylene exchange, while 31 had full acetabular revision. The minimum followup was 2 years (mean, 2.8 years; range, 2–5 years). Three of 36 hips with a retained cup grafted through the cup holes failed within 5 years due to acetabular loosening. One of 31 hips with full revision underwent re-revision for aseptic cup loosening at 5 months postoperatively. Although we do not recommend prophylactic revision of all cups for polywear and osteolysis, the patient may be warned of the possibility of an approximate 10% failure rate when retaining the acetabular component. We do, however, advocate cup extraction in the following situations: damage to the locking mechanism, erosion of the femoral head through the liner and into the cup damaging the metal, and a malpositioned component that may jeopardize the stability of the revision.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.


  1. 1.
    Blom AW, Astle L, Loveridge J, Learmonth ID. Revision of an acetabular liner has a high risk of dislocation. J Bone Joint Surg Br. 2005;87:1636–1638.PubMedCrossRefGoogle Scholar
  2. 2.
    Boucher HR, Lynch C, Young AM, Engh CA Jr, Engh C Sr. Dislocation after polyethylene liner exchange in total hip arthroplasty. J Arthroplasty. 2003;18:654–657.PubMedCrossRefGoogle Scholar
  3. 3.
    Earll MD, Fehring TK, Griffin WL, Mason JB, McCoy T, Odum S. Success rate of modular component exchange for the treatment of an unstable total hip arthroplasty. J Arthroplasty. 2002;17:864–869.PubMedCrossRefGoogle Scholar
  4. 4.
    Eskelinen A, Remes V, Helenius I, Pulkkinen P, Nevalainen J, Paavolainen P. Uncemented total hip arthroplasty for primary osteoarthritis in young patients: a mid-to long-term follow-up study from the Finnish Arthroplasty Register. Acta Orthop. 2006;77:57–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Hendrich C, Engelmaier F, Mehling I, Sauer U, Kirschner S, Martell JM. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. Surgical technique. J Bone Joint Surg Am. 2007;89 Suppl 2 Pt.1:54–67.PubMedCrossRefGoogle Scholar
  6. 6.
    Hozack WJ, Mesa JJ, Carey C, Rothman RH. Relationship between polyethylene wear, pelvic osteolysis, and clinical symptomatology in patients with cementless acetabular components. A framework for decision making. J Arthroplasty. 1996;11:769–772.PubMedCrossRefGoogle Scholar
  7. 7.
    Koulouvaris P, Stafylas K, Xenakis T. Cementless modular centroid reconstruction cup in young adults with congenital dysplasia of the hip. J Arthroplasty. 2008;23:79–85.PubMedCrossRefGoogle Scholar
  8. 8.
    Kurtz S, Lau E, Halpern M, Ong K. Trend shows growing orthopedic surgery case load. Will surgeons be able to keep up? Mater Manag Health Care. 2006;15:61–62.PubMedGoogle Scholar
  9. 9.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRefGoogle Scholar
  10. 10.
    Kurtz SM, Ong KL, Schmier J, Mowat F, Saleh K, Dybvik E, Karrholm J, Garellick G, Havelin LI, Furnes O, Malchau H, Lau E. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89 Suppl 3:144–151.PubMedCrossRefGoogle Scholar
  11. 11.
    Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res. 2006;447:34–38.PubMedCrossRefGoogle Scholar
  12. 12.
    Lachiewicz PF, Soileau E, Ellis J. Modular revision for recurrent dislocation of primary or revision total hip arthroplasty. J Arthroplasty. 2004;19:424–429.PubMedCrossRefGoogle Scholar
  13. 13.
    Lie SA, Hallan G, Furnes O, Havelin LI, Engesaeter LB. Isolated acetabular liner exchange compared with complete acetabular component revision in revision of primary uncemented acetabular components: a study of 1649 revisions from the Norwegian Arthroplasty Register. J Bone Joint Surg Br. 2007;89:591–594.PubMedCrossRefGoogle Scholar
  14. 14.
    Maloney WJ, Herzwurm P, Paprosky W, Rubash HE, Engh CA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as part of a total hip replacement. J Bone Joint Surg Am. 1997;79:1628–1634.PubMedGoogle Scholar
  15. 15.
    Maloney WJ, Woolson ST. Increasing incidence of femoral osteolysis in association with uncemented Harris-Galante total hip arthroplasty. A follow-up report. J Arthroplasty. 1996;11:130–134.PubMedCrossRefGoogle Scholar
  16. 16.
    O’Brien JJ, Burnett RS, McCalden RW, MacDonald SJ, Bourne RB, Rorabeck CH. Isolated liner exchange in revision total hip arthroplasty: clinical results using the direct lateral surgical approach. J Arthroplasty. 2004;19:414–423.PubMedCrossRefGoogle Scholar
  17. 17.
    Paprosky W, Sporer S, O’Rourke MR. The treatment of pelvic discontinuity with acetabular cages. Clin Orthop Relat Res. 2006;453:183–187.PubMedCrossRefGoogle Scholar
  18. 18.
    Schmalzried TP, Guttmann D, Grecula M, Amstutz HC. The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis. J Bone Joint Surg Am. 1994;76:677–688.PubMedGoogle Scholar
  19. 19.
    Wade FA, Rapuri VR, Parvizi J, Hozack WJ. Isolated acetabular polyethylene exchange through the anterolateral approach. J Arthroplasty. 2004;19:498–500.PubMedCrossRefGoogle Scholar
  20. 20.
    Wroblewski BM, Siney PD, Fleming PA. Charnley low-frictional torque arthroplasty in young rheumatoid and juvenile rheumatoid arthritis: 292 hips followed for an average of 15 years. Acta Orthop. 2007;78:206–210.PubMedCrossRefGoogle Scholar
  21. 21.
    Zhang H, Cheng JQ, Shen B, Yang XN, Shi R, Pei FX. Cementless total hip arthroplasty in Chinese patients with osteonecrosis of the femoral head. J Arthroplasty. 2008;23:102–111.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Camilo Restrepo
    • 1
  • Elie Ghanem
    • 1
  • Carrie Houssock
    • 1
  • Mathew Austin
    • 1
  • Javad Parvizi
    • 1
  • William J. Hozack
    • 1
  1. 1.Department of Orthopaedic SurgeryThomas Jefferson University Hospital, Rothman InstitutePhiladelphiaUSA

Personalised recommendations