Early osteolysis following total hip arthroplasty with use of a Hylamer liner in combination with a modular ceramic femoral head. A case report.

Abstract

In an effort to improve the surface and wear characteristics of ultra-high molecular weight polyethylene, an enhanced ultra-high molecular weight polyethylene (Hylamer; DePuy-DuPont Orthopaedics, Wilmington, Delaware)6 was introduced in 1991. It was anticipated that the wear characteristics of a Hylamer acetabular surface in combination with a ceramic modular femoral head would improve the long-term performance of prostheses in young, active patients4,25. Several recent reports, however, have described wear and early osteolysis in association with Hylamer acetabular liners coupled with cobalt-chromium modular femoral heads manufactured by various companies3,15. The purpose of the current report is to describe rapid wear and early osteolysis following use of a Hylamer acetabular liner in combination with a ceramic femoral head made by the same manufacturer. In April 1994, a total hip arthroplasty was performed on a thirty-three-year-old woman (height, 167 centimeters; weight, fifty-two kilograms) who had arthritis due to congenital dysplasia of the left hip. The patient's preoperative work activities as an accountant had required frequent climbing and descending of multiple sets of stairs, which had greatly aggravated the problems with the hip. The work environment subsequently was modified to better accommodate the patient. The arthroplasty was performed with use of components from the same manufacturer. These included a femoral component (Stability; DePuy Orthopaedics, Warsaw, Indiana) measuring twelve by 150 millimeters, which was inserted without cement; an acetabular shell (Duraloc; DePuy Orthopaedics) with a diameter of fifty-two millimeters, also inserted without cement; a Ti-6Al-4V bone-screw (Low Profile; DePuy Orthopaedics) with a diameter of 6.5 millimeters and a length of thirty millimeters, for augmentation of the cup; and a neutral Hylamer liner measuring fifty-two by twenty-eight millimeters with a thickness of eight millimeters. Because of the patient's young age, activity level, and life expectancy, an aluminum-oxide-ceramic modular …