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Cementing a Liner into a Stable Cementless Acetabular Shell: The Double-Socket Technique
Paul E. Beaulé, MD, FRCSC1; Edward Ebramzadeh, PhD1; Michel LeDuff, MA1; Rajiv Prasad, MD1; Harlan C. Amstutz, MD1
1 Joint Replacement Institute, Orthopaedic Hospital/University of California at Los Angeles, 2400 South Flower Street, Los Angeles, CA 90007. E-mail address for P.E. Beaulé: pbeaule@laoh.ucla.edu
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 Los Angeles Orthopaedic Hospital Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, California

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 May 01;86(5):929-934
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Background: During revision hip replacement surgery, the cementless acetabular shell is often well fixed but the locking mechanism may be ineffective. Cementing a new liner into the existing acetabular shell (the double-socket technique) can provide a simple solution. The purposes of the present study were to review our initial clinical results and to define the potential limitations of this technique.

Methods: Thirty-two hips with a preexisting well-fixed acetabular socket that had been in situ for an average of 8.6 years were treated with the insertion of a new polyethylene liner (seventeen hips) or a metal liner (fifteen hips) with use of cement. The indication for this technique was a deficient locking mechanism in twenty-two hips and the unavailability of a matching liner in ten hips. Anteroposterior radiographs of all hips were analyzed by a single independent reviewer.

Results: The mean duration of follow-up was 5.1 years. Six hips required a reoperation after a mean of 29.7 months; the reasons for the reoperations included aseptic failure of the acetabular construct (four hips), instability (one hip), and sepsis (one hip). The University of California at Los Angeles hip scores improved significantly (p < 0.001) compared with the preoperative values; specifically, the mean score improved from 6.2 to 9.1 for pain, from 6.3 to 8.3 for walking, from 6.2 to 7.8 for function, and from 4.7 to 5.8 for activity. The prevalence of dislocation was 22%. Kaplan-Meier analysis with revision as the end point revealed a five-year survival rate of 78% (95% confidence interval, 55% to 91%).

Conclusions: The double-socket technique is a good alternative to acetabular socket removal for suitable candidates who have a well-fixed cementless socket with an inner diameter that is larger than the outer diameter of the cemented liner. This technique preserves acetabular bone stock and permits conversion to alternate bearing surfaces. We believe, however, that removal of a well-fixed acetabular shell or the use of a constrained liner should be strongly considered for patients with a history of 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.

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    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.
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