ISOLATED LINER EXCHANGE IN REVISION TOTAL HIP ARTHROPLASTY: RESULTS VIA THE DIRECT LATERAL SURGICAL APPROACH

Abstract

Introduction and Aims: Polyethylene wear in total hip arthroplasty (THA) is frequently associated with wellfixed cementless implants. Purpose: To evaluate the clinical and radiographic results of the isolated liner exchange (ILE) procedure in revision THA via the direct lateral surgical approach.

Method: A prospective study of 24 hips that underwent an ILE revision procedure via the direct lateral approach was conducted. Accessible osteolytic lesions were managed with curettage and bone grafting. Clinical data including Harris hip score, WOMAC Index, SF-12, and radiographic analysis were recorded. The area of osteolytic lesions was calculated using a new software program.

Results: This is the first study to our knowledge to report on the results of the ILE procedure performed via the direct lateral surgical exposure. Twenty-three patients underwent 24 revisions with an ILE. At mean follow-up of 40 months, all osteolytic lesions had regressed. Harris hip scores improved from 69 to 83. WOMAC indices improved from 37 to 24. No dislocations have occurred. Two patients have required revision. Isolated liner exchange for polyethylene wear is a promising technique that avoids the removal of well-fixed acetabular implants. The increased dislocation rate associated with this revision THA procedure may be reduced and osteolytic lesions may be successfully debrided and bone grafted through the direct lateral approach.

Conclusion: The ILE procedure, when performed via the direct lateral surgical approach, may reduce the dislocation rate commonly reported via the posterolateral exposure with this procedure. Retention of well-fixed implants and bone grafting preserves bone stock and adequately addresses osteolytic lesions at revision surgery through this exposure.