Abstract
Reoperation on the acetabular side of the total hip arthroplasty construct because of acetabular liner wear with or without extensive osteolysis is the most common reoperation performed in revision hip surgery today. The options of revision of the component or component retention, liner exchange (cemented or direct reinsertion) and bone grafting represent a classic surgeon dilemma of choices and compromises.
CT scanning is helpful in determining the size and location of osteolytic lesions. My preference is to retain the existing shell when possible especially when there are large osteolytic lesions but where structural support is maintained.
The advantages of complete revision are easy access to lytic lesions, ability to change component position and the ability to use contemporary designs with optimal bearing surfaces (for wear and dislocation prevention).
The disadvantage is bone disruption including pelvic discontinuity with component removal (less so with Explant Systems) and difficult reconstructions due to excessive bone loss from the osteolytic defects (sometimes requiring cup cages).
The advantage of component retention is that structural integrity of the pelvis is maintained and in general, a higher quality polyethylene is utilised. For large lesions I use windows to debride and bone graft the lesions. If the locking mechanism is inadequate, cementing a liner, including a constrained liner in some cases, that has been scored in a spider web configuration provides durable results at 5-year follow-up. The downside to liner exchange is potential instability. We immobilise all liner exchange patients postoperatively.
