Using intraoperative radiography to detect incomplete seating of Trident acetabular system ceramic liners

Abstract

There have been some reports of incomplete seating of the ceramic liner in the Stryker Trident acetabular system. We sought to prevent incomplete seating through the use of intraoperative radiography. We retrospectively reviewed 21 hips in 18 patients who had undergone total hip arthroplasty using a posterolateral approach with a Stryker Trident ceramic liner. All procedures included an intraoperative anteroposterior view radiograph to evaluate liner seating. If incomplete seating was recognized we reinserted the liner. We investigated whether this technique made it possible to detect and correct incomplete seating. Six of the 21 hips evidenced incomplete seating. In four of these hips, the incomplete seating was revealed on the intraoperative radiograph: two were reinserted properly, one was replaced with a polyethylene liner, and in the last one the incomplete seating was missed despite the radiographical evidence. The location of the gap between the socket and liner caused by the incomplete seating was inferior in all these cases. Intraoperative radiography did not indicate incomplete seating in two hips in which the location of the gap was anterior; the problem was revealed by postoperative lateral view radiography. With a posterolateral approach in a lateral decubitus position, the use of intraoperative radiography was effective when the gaps were superior or inferior. However, this approach made it easy to miss anterior gaps and intraoperative radiography did not reveal them.