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Polyethylene liner cementation into a well-fixed metal acetabular shell for the management of periacetabular osteolysis: a systematic review

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Abstract

Purpose

Although various papers have reported on the clinical performance of cup retention with cementation of a new liner and bone grafting in the management of well-fixed cups with polyethylene wear and periacetabular osteolysis after total hip arthroplasty (THA), no systematic review of this topic has been published to date.

Methods

Medline, EMBASE and Cochrane Library were searched for articles published from January 1999 to January 2019 using “osteolysis” AND “well-fixed”, “osteolysis” AND “retro-acetabular”, “bone graft” AND (“retention” OR “retained” OR “stable”) AND “cup”, and “cemented liner” AND “well-fixed”.

Results

Nine articles were selected for review (186 cases, 76.1 months mean follow-up). The overall revision rate was 11.3% (21 hips) most commonly due to aseptic loosening (9/186 hips), dislocation (8/186 hips), and liner wear progression (2/186 cases). The reported square size of osteolytic lesions ranged from a mean of 465.84 mm2 to a max of 4,770 mm2. Almost all reported lesions treated with bone grafts resolved or did not progress 97% (72/74). All studies indicated improved pain and functional scores at follow-up.

Conclusion

Cementation of a new liner with periacetabular bone grafting provides an alternative option to isolated liner exchange and cup revision for the management of periacetabular osteolysis in well-fixed cups with a disrupted locking mechanism or unavailable exchange liner. Further higher quality studies are required in order to examine if the use of highly cross-linked polyethylene, highly porous-coated cups, hydroxyapatite-coated cups, and small-diameter cups influence the clinical outcome of liner cementation in well-fixed cups with periacetabular osteolysis.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA

    Michael-Alexander Malahias, Alex Gu, Ioannis Gkiatas & Peter K. Sculco

  2. Department of Orthopedic Surgery, Fuzhou Second Hospital Affiliated To Xiamen University, Fuzhou, 350007, Fujian, China

    Qian-Li Ma

  3. Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA

    Seong J. Jang

  4. Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Marios Loucas

  5. Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington, DC, 20037, USA

    Alex Gu

  6. Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland

    Jean-Claude Sedran

  7. 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Vasileios S. Nikolaou

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  1. Michael-Alexander Malahias
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Correspondence to Seong J. Jang.

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Malahias, MA., Ma, QL., Jang, S.J. et al. Polyethylene liner cementation into a well-fixed metal acetabular shell for the management of periacetabular osteolysis: a systematic review. Eur J Orthop Surg Traumatol 32, 1459–1468 (2022). https://doi.org/10.1007/s00590-021-03130-w

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  • DOI: https://doi.org/10.1007/s00590-021-03130-w

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