Abstract
Purpose
In total hip arthroplasty (THA) the use of a polyethylene (PE) insert with a hooded rim can be considered to reduce dislocation risks. This benefit has to be balanced against the potential introduction of impingement of the femoral component on this rim. We present a case series of early acetabular revisions for excessive PE wear and acetabular bone defects from overuse of such a hooded rim insert.
Material and methods
Twenty-eight patients with 34 consecutive early acetabular revisions were evaluated on failure mechanism. One type of implant was used in all cases. Standard pelvic radiographs and pre-operative CT scans were used to quantify PE wear, implant positioning and acetabular bone defects.
Results
An acetabular revision with impaction grafting was performed in all cases with a mean cup survival of ten years (range 1.3–19.3). No concurrent stem revisions were necessary. Overall implant positioning was adequate with a mean cup inclination of 45° (range 39–57) and anteversion of 25° (range eight to 45). The mean PE wear was 0.24 mm/year (range 0.00–1.17). The mean acetabular bone defect on pelvic CT scans was calculated as 352 mm² (range zero to 1107) and 369 mm² (range zero to 1300) in the coronal and transversal planes, respectively. A hooded acetabular insert was retrieved in all cases and profound PE wear, typically from the posterior hooded rim, was encountered.
Conclusion
The use of hooded acetabular inserts may be considered to improve implant stability intra-operatively. This case series clearly presents that together with these devices, component impingement with concordant complications such as accelerated PE wear may be introduced. Standard use of these stabilizing inserts should thus be avoided.
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References
Clark CR, Heckman JD (2001) Volume versus outcomes in orthopaedic surgery: a proper perspective is paramount. J Bone Joint Surg Am 83-A(11):1619–1621
Battaglia TC, Mulhall KJ, Brown TE, Saleh KJ (2006) Increased surgical volume is associated with lower THA dislocation rates. Clin Orthop Relat Res 447:28–33
Paterno SA, Lachiewicz PF, Kelley SS (1997) The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. J Bone Joint Surg Am 79(8):1202–1210
Scifert CF, Brown TD, Lipman JD (1999) Finite element analysis of a novel design approach to resisting total hip dislocation. Clin Biomech (Bristol Avon) 14(10):697–703
Hall RM, Siney P, Unsworth A, Wroblewski BM (1998) Prevalence of impingement in explanted Charnley acetabular components. J Orthop Sci 3(4):204–208
Isaac GH, Wroblewski BM, Atkinson JR, Dowson D (1992) A tribological study of retrieved hip prostheses. Clin Orthop Relat Res 276:115–125
Yamaguchi M, Akisue T, Bauer TW, Hashimoto Y (2000) The spatial location of impingement in total hip arthroplasty. J Arthroplasty 15(3):305–313
Martell JM, Berdia S (1997) Determination of polyethylene wear in total hip replacements with use of digital radiographs. J Bone Joint Surg Am 79(11):1635–1641
Rahman L, Cobb J, Muirhead-Allwood S (2012) Radiographic methods of wear analysis in total hip arthroplasty. J Am Acad Orthop Surg 20(12):735–743
Livermore J, Ilstrup D, Morrey B (1990) Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am 72(4):518–528
Watt I et al (2006) Hip arthroplasty, normal and abnormal imaging findings. Available from: http://www.radiologyassistant.nl/en/p431c8258e7ac3/hip-arthroplasty.html. Accessed 28 March 2014
Mian SW, Truchly G, Pflum FA (1992) Computed tomography measurement of acetabular cup anteversion and retroversion in total hip arthroplasty. Clin Orthop Relat Res 276:206–209
Shon WY, Baldini T, Peterson MG, Wright TM, Salvati EA (2005) Impingement in total hip arthroplasty a study of retrieved acetabular components. J Arthroplasty 20(4):427–435
Hallan G, Lie SA, Havelin LI (2006) High wear rates and extensive osteolysis in 3 types of uncemented total hip arthroplasty: a review of the PCA, the Harris Galante and the Profile/Tri-Lock Plus arthroplasties with a minimum of 12 years median follow-up in 96 hips. Acta Orthop 77(4):575–584
van der Veen HC, van Jonbergen HP, Poolman RW, Bulstra SK, van Raay JJ (2013) Is there evidence for accelerated polyethylene wear in uncemented compared to cemented acetabular components? A systematic review of the literature. Int Orthop 37(1):9–14
Usrey MM, Noble PC, Rudner LJ, Conditt MA, Birman MV, Santore RF, Mathis KB (2006) Does neck/liner impingement increase wear of ultrahigh-molecular-weight polyethylene liners? J Arthroplasty 21(6 Suppl 2):65–71
Demmelmeyer U, Schraml A, Honle W, Schuh A (2010) Long-term results of the standard Wagner cup. Int Orthop 34(1):33–37
Schmalzried TP, Brown IC, Amstutz HC, Engh CA, Harris WH (1999) The role of acetabular component screw holes and/or screws in the development of pelvic osteolysis. Proc Inst Mech Eng H 213(2):147–153
Yamaguchi M, Bauer TW, Hashimoto Y (1999) Deformation of the acetabular polyethylene liner and the backside gap. J Arthroplasty 14(4):464–469
Farizon F, de Lavison R, Azoulai JJ, Bousquet G (1998) Results with a cementless alumina-coated cup with dual mobility. A twelve-year follow-up study. Int Orthop 22(4):219–224
Nieuwenhuis JJ, Malefijt Jde W, Hendriks JC, Gosens T, Bonnet M (2005) Unsatisfactory results with the cementless Omnifit acetabular component due to polyethylene and severe osteolysis. Acta Orthop Belg 71(3):294–302
Krushell RJ, Burke DW, Harris WH (1991) Elevated-rim acetabular components. Effect on range of motion and stability in total hip arthroplasty. J Arthroplasty 6(Suppl):S53–S58
Jaramaz B, DiGioia AM 3rd, Blackwell M, Nikou C (1998) Computer assisted measurement of cup placement in total hip replacement. Clin Orthop Relat Res 354:70–81
Seki M, Yuasa N, Ohkuni K (1998) Analysis of optimal range of socket orientations in total hip arthroplasty with use of computer-aided design simulation. J Orthop Res 16(4):513–517
Gallo J, Havranek V, Zapletalova J (2010) Risk factors for accelerated polyethylene wear and osteolysis in ABG I total hip arthroplasty. Int Orthop 34(1):19–26
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Gerhardt, D.M.J.M., Sanders, R.J.M., de Visser, E. et al. Excessive polyethylene wear and acetabular bone defects from standard use of a hooded acetabular insert in total hip arthroplasty. International Orthopaedics (SICOT) 38, 1585–1590 (2014). https://doi.org/10.1007/s00264-014-2333-y
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DOI: https://doi.org/10.1007/s00264-014-2333-y