0
Scientific Articles   |    
A Constrained Liner Cemented into a Secure Cementless Acetabular Shell
John J. Callaghan, MD1; Javad Parvizi, MD2; Clifford C. Novak, MD1; Barron Bremner, DO2; Wade Shrader, MD2; David G. Lewallen, MD2; Richard C. Johnston, MD1; Devon D. Goetz, MD3
1 Department of Orthopaedic Surgery, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for J.J. Callaghan: john-callaghan@uiowa.edu
2 Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
3 Des Moines Orthopaedic Surgeons, 6001 Westown Parkway, West Des Moines, IA 50266
View Disclosures and Other Information
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health Bioengineering Research Partnership Grants AR46601 and AR47653, the Veterans Affairs Merit Award, and DePuy. In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy). Also, a commercial entity (DePuy) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the University of Iowa College of Medicine, Iowa City; Iowa Methodist Medical Center, Des Moines, Iowa; and the Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Oct 01;86(10):2206-2211
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Constrained acetabular components have been used to treat hips with recurrent instability following total hip arthroplasty and hips that demonstrate instability during revision surgery. In such hips, when a secure cementless acetabular shell is present, the surgeon can cement a constrained liner into the existing shell. The purpose of this study was to evaluate the clinical and radiographic outcome of this technique with use of a tripolar constrained liner that was cemented into a well-fixed cementless acetabular shell.

Methods: Between 1988 and 2000, constrained liners were cemented into thirty-one well-fixed cementless acetabular shells at three centers. The average age of the patients at the time of the index surgery was 72.1 years, and the indications for the procedure were recurrent hip instability in sixteen hips and intraoperative instability in fifteen hips. The patients were evaluated with respect to the clinical outcome and radiographic evidence of shell loosening and osteolysis.

Results: At an average duration of follow-up of 3.9 years, twenty-nine liners (94%) were securely fixed in the cementless shells and two constrained liners had failed. One liner failed because it separated from the cement, and one failed because of fracture of the capturing mechanism. Both hips were successfully revised with another cemented tripolar constrained liner. No acetabular component demonstrated radiographic evidence of progressive loosening or osteolysis.

Conclusions: A constrained tripolar liner cemented into a secure, well-positioned cementless acetabular shell provides stability and durability at short-term follow-up. Careful attention to the preparation of the liner, the sizing of the component, and the cementing technique are likely to reduce the failure of this construct, which can be used for difficult cases of total hip instability.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Hip
    Related Audio and Videos
    PubMed Articles
    Guidelines
    ACR Appropriateness Criteria® acute hand and wrist trauma. -American College of Radiology | 7/17/2009
    ACR Appropriateness Criteria® acute trauma to the knee. -American College of Radiology | 7/17/2009
    Results provided by:
    PubMed
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    04/16/2014
    Ohio - OhioHealth Research and Innovation Institute (OHRI)
    11/15/2013
    Louisiana - Ochsner Health System
    01/08/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center