Polyethylene liner dissociation in a DePuy pinnacle cup with a manufacturer analysis of the failed component

2021 ◽  
Vol 14 (2) ◽  
pp. e238333
Author(s):  
David Keohane ◽  
Gerard A Sheridan ◽  
James Harty ◽  
Padhraig O'Loughlin
Keyword(s):  
Emergency Department ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Detailed Analysis ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Polyethylene Liner ◽  
Radiographic Imaging ◽  
Root Cause ◽  
Acetabular Shell

A 74-year-old patient presented to the emergency department with acute atraumatic hip pain 9 years after her primary left total hip arthroplasty (THA). Plain radiographic imaging demonstrated lateralisation of the femoral head within the acetabular shell—indicating an issue with the polyethylene liner. The patient required revision of the acetabular component and the femoral head, as well as a new polyethylene liner. A detailed analysis of the components removed was performed by DePuy Synthes Engineering. Between 2009 and 2020, 8 publications have documented 52 cases of liner dissociation with the Pinnacle acetabular component and Marathon polyethylene liner. Various theories have been proposed in the literature as all of these components appear to fail in the same way, with shearing of the locking tabs in the polyethylene liner. In spite of a manufacturer analysis of the components, no root cause was identified as to why the polyethylene liner failed.

Radiolucent lines do not affect the longevity of highly cross-linked polyethylene cemented components in total hip arthroplasty

2021 ◽  
Vol 103-B (10) ◽  
pp. 1604-1610
Author(s):  
Yusuke Takaoka ◽  
Koji Goto ◽  
Jiro Tamura ◽  
Yaichiro Okuzu ◽  
Toshiyuki Kawai ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Long Term Outcome ◽  
Total Hip ◽  
Radiolucent Lines ◽  
Kaplan Meier ◽  
Acetabular Components

Aims We aimed to evaluate the long-term outcome of highly cross-linked polyethylene (HXLPE) cemented acetabular components and assess whether any radiolucent lines (RLLs) which arose were progressive. Methods We retrospectively reviewed 170 patients who underwent 187 total hip arthroplasties at two hospitals with a minimum follow-up of ten years. All interventions were performed using the same combination of HXLPE cemented acetabular components with femoral stems made of titanium alloy. Kaplan-Meier survival analysis was performed for the primary endpoint of acetabular component revision surgery for any reason and secondary endpoint of the appearance of RLLs. RLLs that had appeared once were observed over time. We statistically assessed potential relationships between RLLs and a number of factors, including the technique of femoral head autografting and the Japanese Orthopaedic Association score. Results The mean follow-up period was 13.0 years (10.0 to 16.3). Femoral head autografting was performed on 135 hips (72.2%). One acetabular component was retrieved because of deep infection. No revision was performed for the aseptic acetabular loosening. The Kaplan-Meier survival curve for the primary and secondary endpoints were 98.2% (95% confidence interval (CI) 88.6% to 99.8%) and 79.3% (95% CI 72.8% to 84.6%), respectively. RLLs were detected in 38 hips (21.2%), at a mean of 1.7 years (1 month to 6 years) postoperatively. None of the RLLs were progressive, and the presence of RLLs did not show a significant association with the survival and clinical score. RLLs were more frequently observed in hips without femoral head autografts than in those with autografts. Conclusion The use of HXLPE cemented acetabular components in total hip arthroplasty demonstrated excellent clinical outcomes after ten years, and no RLLs were progressive, and their presence did not affect the outcome. Femoral head autografting did not negatively impact the acetabular component survival or the appearance of RLLs. Cite this article: Bone Joint J 2021;103-B(10):1604–1610.

Polyethylene Liner and Femoral Head Exchange in Total Hip Arthroplasty

2019 ◽  
Vol 101 (5) ◽  
pp. 421-428 ◽  
Author(s):  
Stephen M. Petis ◽  
Bernd Kubista ◽  
Robert U. Hartzler ◽  
Matthew P. Abdel ◽  
Daniel J. Berry
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Polyethylene Liner ◽  
Total Hip

scholarly journals Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Tomoya Takasago ◽  
Tomohiro Goto ◽  
Keizo Wada ◽  
Daisuke Hamada ◽  
Toshiyuki Iwame ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Polyethylene Liner ◽  
Metal Debris ◽  
Ceramic Fracture ◽  
Total Hip ◽  
Metal Implants ◽  
Revision Tha ◽  
Ceramic Liner

The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis.

Radiographic Native Femoral Head Size Correlates with Acetabular Cup Size in Primary Total Hip Arthroplasty

2019 ◽  
Vol 03 (04) ◽  
pp. 197-202
Author(s):  
Daniel Pfeufer ◽  
Jeremy Gililland ◽  
Rane Ajinkya ◽  
Ian Duensing ◽  
Mike B. Anderson ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Head Size ◽  
Radiographic Measurement ◽  
Femoral Head Size ◽  
Acetabular Cup ◽  
Component Size ◽  
Primary Total Hip Arthroplasty

AbstractThere is very little literature on whether a simple radiographic measurement of native femoral head size correlates with implanted acetabular cup size. We hypothesized that there would be a high correlation between the radiographically measured native femoral head and implanted acetabular component size in primary total hip arthroplasty (THA). We conducted a retrospective study of 277 consecutive patients who underwent primary THA. Patients with prior contralateral THA or a history of congenital deformity were excluded (n = 95). We used the postoperative anteroposterior (AP) pelvic view to calibrate the image using known implanted femoral head component size. We then measured the diameter of the contralateral native femoral head under the assumption that femoral heads are generally symmetrical in patients. Two of the authors performed all measurements. To determine if native femoral head size was correlated with acetabular component size we used the Pearson correlation coefficient (r). There was a high correlation between contralateral native femoral head size and acetabular component size (r = 0.86, 95% confidence interval [CI]: 0.82–0.89). The median difference in radiographically measured native femoral head size and acetabular component size was 7 mm (interquartile range [IQR] = 5–8). Our data showed a high correlation between acetabular component size and radiographically measured contralateral native femoral head size, with the difference being 7 mm. In addition to verifying the actual femoral head size with calipers during surgery, this simple radiographic measurement, which could be done on the affected or contralateral hip, may help surgeons to plan better and improve preoperative templating in primary THA.

scholarly journals Early Intraprosthetic Dislocation of Dual-Mobility Total Hip Arthroplasty Implant Following Attempted Closed Reduction: A Case Report

2014 ◽  
Vol 5 (2) ◽  
pp. 23-26 ◽  
Author(s):  
Joseph Schirmers, MD ◽  
Ryan Horazdovsky, MD ◽  
Scott Marston, MD
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Late Complication ◽  
Polyethylene Liner ◽  
Consecutive Series ◽  
Original Design ◽  
Dual Mobility ◽  
Total Hip ◽  
Intraprosthetic Dislocation

Introduced in 1974 by Bousquet, the dual-mobility bearing for use in total hip arthroplasty (THA) confers increased jump distance and improved overall stability relative to conventional THA designs [1-3]. The dual-mobility bearing incorporates a relatively small (22-28mm) metal or ceramic femoral head press fit into a larger polyethylene liner which articulates with the acetabular component. Dissociation of the femoral head from the polyethylene liner (intraprosthetic dislocation) is a known late complication thought to be related to polyethylene liner wear and has been previously reported [2-7]. In a consecutive series of 384 primary THAs employing Bousquet’s original design, there were 14 intraprosthetic dislocations over 15 years (3.6%). The authors cited polyethylene wear as causative and mean time to intraprosthetic dislocation was 8.9 years [2].

Total Hip Arthroplasty Functional Outcomes Are Independent of Acetabular Component Orientation When a Polyethylene Liner Is Used

2016 ◽  
Vol 31 (4) ◽  
pp. 830-834.e3 ◽  
Author(s):  
Jacob T. Bobman ◽  
Jonathan R. Danoff ◽  
Oladapo M. Babatunde ◽  
Kaicen Zhu ◽  
Katie Peyser ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Polyethylene Liner ◽  
Total Hip ◽  
Component Orientation
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