Abstract
Isolated liner exchange in revision total hip arthroplasty for the treatment of polyethylene wear is an increasingly common surgical procedure. Twenty-four hips underwent this procedure via the direct lateral approach and were prospectively followed clinically and radiographically. Accessible osteolytic lesions were curetted and bone grafted. At a mean follow-up of forty months, a significant clinical improvement was observed. One cup collapsed into an osteolytic lesion postoperatively; all other lesions regressed. No dislocations have occurred. Isolated liner exchange via the direct lateral approach may reduce dislocation rates while avoiding the morbidity associated with the removal of well-fixed components.
The purpose of this study was to evaluate the clinical and radiographic results of isolated liner exchange in revision total hip arthroplasty (THA) for osteolysis and polyethylene wear via the direct lateral surgical approach.
Retention of well-fixed implants avoids unnecessary bone loss at revision surgery. Previous studies report a significant dislocation rate with isolated liner exchange. Revision via the direct lateral surgical approach may reduce the dislocation rate in surgery for acetabular osteolysis.
Twenty-four hips that underwent an isolated liner exchange revision procedure via the direct lateral approach were prospectively followed. Accessible osteolytic lesions were curetted and bone grafted. Harris Hip Score, WOMAC Index, and radiographic analysis were recorded. The area of osteolytic lesions was calculated using a computer imaging technique.
At mean follow-up of forty months, all except one of the osteolytic lesions had regressed in size. Mean Harris Hip scores improved from sixty-nine to eighty-three and WOMAC indices improved from thirty-seven to twenty-four. No dislocations have occurred. One cup collapsed into an osteolytic lesion postoperatively, requiring an acetabular revision procedure.
Isolated liner exchange is a promising technique that avoids the removal of well-fixed acetabular implants. The increased dislocation rate associated with revision THA may be reduced and osteolytic lesions may be debrided and bone grafted through the direct lateral approach.
Isolated liner exchange via the direct lateral approach reduces the dislocation rate in THA. Retention of wellfixed implants and bone grafting is a procedure that preserves bone stock and addresses osteolytic lesions at revision surgery.
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
