“Cup-in-Cup” for revision cup in total hip arthroplasty – An innovative technique

Abstract

In a revision hip surgery with isolated poly-ethylene liner wear along with a stable acetabular shell involves difficult decision of revising the entire acetabular component or just the liner. However, unavailability of the similar poly liner in a high risk patient can be dealt with a novel technique of cup in cup by retaining the stable shell and cementing a polyethylene liner over it. A 77-year-old male came with complains of pain in the right hip and limp of 4 months duration after 17 years of a revision hip surgery. Poly-ethylene liner was found worn out intraoperative with both the metal shell and the stem very stable. Same company poly liner was not available. In order to prevent the extensive revision in a high surgical risk patient and to prevent the blood and the bone loss, a new Elite poly-ethylene cement cup was cemented over the old stable cementless metal shell. At 3 years short term follow up patient is able to walk pain free independently. The “cup-in-cup” technique with cemented PE cup into a retained well-fixed and well-positioned metal shell is a good technique in high surgical risk patients and gives promising result at short term follow up.