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Dislodgment of Polyethylene Liners in First and Second-Generatio­n Harris-Galante Acetabular Components A Report of Eighteen Cases
Alejandro González DellaValle, MD; Patricio Salonia Ruzo, MD; Stephen Li, PhD; Paul Pellicci, MD; Thomas P. Sculco, MD; Eduardo A. Salvati, MD
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Investigation performed at The Hospital for Special Surgery, New York City
Alejandro González Della Valle, MD Department of Orthopedics, Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires C1199ACK, Argentina. E-mail address: agdv@bigfoot.com
Patricio Salonia Ruzo, MD Department of Orthsopedics, Hospital Militar Central de Buenos Aires, 11 de Septiembre 1301, Buenos Aires 1426, Argentina. E-mail address: patricio@bigfoot.com
Stephen Li, PhD Paul Pellicci, MD Thomas P. Sculco, MD Eduardo A. Salvati, MD Departments of Biomechanics (S.L.) and Orthopedic Surgery (P.P., T.P.S., and E.A.S.), The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for S. Li: lis@hss.edu. E-mail address for P. Pellicci: pelliccip@hss.edu. E-mail address for T.P. Sculco: s­culcot@hss.edu. E-mail address for E.A. Salvati: salvatie@hss.edu
One or more of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other nonprofit organization with which one or more of the authors is associated. Funds were received in total or partial support of the research or clinical study presented in this article. The funding sources were the Mr. Lawrence M. Gelb Foundation and The Fanwood Foundation.

J Bone Joint Surg Am, 2001 Apr 01;83(4):553-553
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Abstract

Background:

Dislodgment of the polyethylene liner is an increasingly common complication following total hip arthroplasty. The purposes of this study are to present the results in a series of patients with this complication and to analyze the mode of failure.

Methods:

Between November 1995 and January 2001, eighteen patients who had had a total hip arthroplasty presented with dislodgment of the polyethylene liner from a Harris-Galante metal acetabular shell. The medical records, radiographs, operative notes, and retrieved components were reviewed. In addition, scanning electron microscopy was used to study the fractured surfaces in a shell that had four broken tines.

Results:

The components had been in situ for an average of seven years (range, three to eleven years). Seventeen components were second generation, and one was first generation. Symptoms developed spontaneously in sixteen patients, during sexual intercourse in one, and following a fall on the hip in one. Radiographs showed eccentric positioning of the head in all of the hips and broken tines in six. All of the shells were well fixed. Treatment consisted of revision of the shell in four patients, exchange of the liner in four, cementation of a new liner into the shell in seven, and cementation of an all-polyethylene cup in three. The liners had severe damage of the rim. Scanning-electron microscopy of the fractured surfaces of four tines revealed a fatigue pattern.

Conclusions:

We believe that, as the liner wears and becomes loose because of an inadequate locking mechanism, progressive micromotion occurs and the load increases on the polyethylene rim until it deforms and/or fractures. Subsequently, nothing prevents the liner from rotating out of the shell. As this mechanism of failure appears to include fatigue failure of the locking tines and wear of the liner, this complication is likely to increase as the components age in situ.

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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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