Liner Failure Research Articles

The Trident Constrained Acetabular (Bipolar) Component for Recurrent Dislocation. New Mode of Liner Failure

Recurrent dislocation after reconstructive hip surgery remains a challenging problem to treat. Constrained acetabular components can provide an excellent solution, in selected patients. Failure of constrained components may still occur despite excellent component implantation and occurs at the liner-shell and shell-bone interfaces usually as a result of trauma or aseptic loosening. We describe the failure of a Trident bipolar acetabular component at its bipolar/insert interface, a previously unreported mode of failure.

Unilateral Tibial Polyethylene Liner Failure in Bilateral Total Knee Arthroplasty—Bilateral Retrieval Analysis at 8 Years

This is a report of a unique case of bilateral simultaneous total knee arthroplasties in which one tibial liner failed dramatically, whereas the other liner showed minimal evidence of wear. This unique case allows isolation of component factors as the primary contributing etiology to failure. The differentiating characteristic was the method of sterilization and the shelf life of the polyethylene liner. The insert that showed minimal wear was sterilized with γ radiation in a barrier package and had a shelf life of less than 1 year, whereas the insert that failed dramatically was sterilized in air and had a shelf life of more than 5 years. This case provides a dramatic example of the potential detrimental effects of manufacturing details on the performance of orthopedic implants, particularly polyethylene inserts.

Fiber-Optic Distributed-Temperature-Sensing Technology Used for Reservoir Monitoring in an Indonesia Steam Flood

Summary The world's largest steamflood operation is conducted on the island of Sumatra in Indonesia. Fiber-optic distributed-temperaturesensing (DTS) surveys are used in the Sumatra fields to provide valuable data for reservoir management. The DTS profile data can determine the temperature and extent of a "steam chest," a phenomenon that occurs when steam injected into a steam-injection well moves away from the perforations until it encounters an impermeable barrier in the formation. The steam then extends laterally until breakthrough occurs at the producing well. Because oil is produced by gravity drainage, the steam chest (also known as a steam-saturated volume) grows downward. DTS surveys also have the capacity to determine the temperature gradient for either overburden or underburden reservoirs. This information is vital for properly setting steam-injection target rates. The information is also used to mitigate steam breakthroughs and eruptions, as well as to identify bypass oil. Steamflood operations experience many types of problems, including inefficient injection rates, wasted heat to the casing, sanding in producers, liner failures, and pump failures. There is also an ongoing need to improve the efficiencies of vapor collection systems, well-test stations, and central gathering stations. Based on these challenging problems, periodic wellbore temperature surveys are required to improve heat management and, ultimately, profitability. Conventional temperature logs cannot be run in these wells without first pulling the pumps from the completion. Therefore, a fiber-optic DTS system attached to the production tubing was suggested. This paper will present case histories of successful applications of fiber-optic DTS surveys that improved steamflood management in this steamflood field in Indonesia. The benefits from fiber-optic DTS monitoring were Significant improvement in the understanding of steam breakthrough zones along the pay-zone interval of production wells Improved understanding of the steam path in steam-injector wells Improvement of the real-time temperature profile in observation wells to identify steam-zone development and unswept or bypassed oil zones in the steamflood patterns

The Trident constrained acetabular (bipolar) component for recurrent dislocation. New mode of liner failure

Recurrent dislocation after reconstructive hip surgery remains a challenging problem to treat. Constrained acetabular components can provide an excellent solution, in selected patients. Failure of constrained components may still occur despite excellent component implantation and occurs at the liner-shell and shell-bone interfaces usually as a result of trauma or aseptic loosening. We describe the failure of a Trident bipolar acetabular component at its bipolar/insert interface, a previously unreported mode of failure.

Severe Periprosthetic Metallosis and Polyethylene Liner Failure Complicating Total Hip Replacement: The Cloud Sign

Severe Periprosthetic Metallosis and Polyethylene Liner Failure Complicating Total Hip Replacement: The Cloud Sign

Long-term results of uncemented acetabular cups with an ACS polyethylene liner. A 14–16-year follow-up study

We assessed the clinical and radiographic results of 40 porous-coated acetabular cups with an Acetabular Cup System polyethylene liner over a minimum 14-year follow-up. Femoral head penetration was estimated using a software package. Fifteen cups were revised, 11 due to polyethylene liner rupture. All cups but two were radiographically stable, and 11 hips showed acetabular osteolysis. The overall femoral head penetration rate in hips without liner fracture with reference to the early penetration point was 0.1188+/-0.070 mm per year. Polyethylene liner fractures were associated with higher early femoral head penetration (P<0.0001) and a vertical cup position (P=0.0016). The 14-year survival without cup revision for any reason was 63.9%, 71.8% with no ACS polyethylene liner fracture and 65.3% with no acetabular osteolysis. Most cups showed a good clinical outcome in general, but major Acetabular Cup System liner failure and osteolysis were frequent. Patients with the ACS cups still in place should be monitored closely.

Extrusion of Metal Radiological Marker From a Total Ankle Replacement Insert: A Case Report

Total ankle arthroplasty has become an increasingly performed procedure for the treatment of ankle arthritis. Failures related to polyethylene inserts can result from uncorrected deformities or malalignment of the components. We report a case of a 63-year-old man who underwent total ankle arthroplasty for osteoarthritis of the ankle. The talar component was placed in neutral alignment. Initial postoperative recovery and rehabilitation were unremarkable. At 9 months postoperatively, plain radiographs of the ankle showed worsening varus tilt when compared with radiographs taken earlier. There was also radiographic evidence of separation of the posterior metal marker, suggestive of a fracture of the polyethylene insert. Revision surgery to correct the varus tilt and replace the polyethylene insert was performed. At operation, the polyethylene insert was found to be intact with no evidence of fracture. The posterior metal marker of the polyethylene insert was found to be extruded from the insert. Small degrees of ankle prosthesis malalignment can lead to various degrees of polyethylene liner failure, such as metal marker extrusion. This article also shows that these metal markers may not be accurate indicators of the integrity of the polyethylene insert.

High wear rates and extensive osteolysis in 3 types of uncemented total hip arthroplasty: A review of the PCA, the Harris Galante and the Profile/Tri-Lock Plus arthroplasties with a minimum of 12 years median follow-up in 96 hips

Background High wear rates and femoral and acetabular osteolysis have been—and still are—the main problems in uncemented total hip replacement. We reviewed 96 consecutive cementless total hip replacements of 4 different designs.Patients and methods 21 PCA, 25 Harris Galante Porous/Harris Galante I (stem/cup), 25 Profile pressfit/ Tri-Lock Plus (stem/cup) and 25 Profile HA-coated/Tri-Lock Plus (stem/cup) prostheses were included. The operations were performed in the period 1984–1991. Median follow-up ranged from 12–16 years. Wear and osteolysis were measured.Results Mean linear wear rates ranged from 0.17 to 0.21 mm/year in the 4 groups, and there were no statistically significant differences between the groups (p = 0.9, ANOVA). Moderate or extensive osteolysis was found in 46 of the 96 hips included. The association between high and low wear rates (more or less than 0.20 mm/ year) and extent of osteolysis was statistically significant (p < 0.001, t-test). We found poor 12-year survival of the primary prostheses in all 4 groups (50–70%), mainly due to revisions because of wear of the polyethylene liner and/or osteolysis. The infrequently documented Profile/Tri-Lock Plus systems did not perform differently from the PCA and the HG.Interpretation The poor long-term results with these uncemented total hip arthroplasties illustrate the necessity of regular radiographic evaluation in order to detect osteolysis and liner failure, which are both generally asymptomatic until catastrophic failure appears.

Polyethylene Liner Failure in Second-Generation Harris-Galante Acetabular Components

Polyethylene liner failure of cementless acetabular components has been reported to be the most common complication of current modular cups. We performed a retrospective review of 128 consecutive primary total hip arthroplasties in 111 patients who had a second-generation Harris-Galante cup (Harris-Galante II, Zimmer, Warsaw, Ind). The mean length of the follow-up period was 8.0 years (range 5-12.9 years), with 26 cups (20.2%) having undergone revision by that time. Twenty-two hips (17.3%) had failure of the polyethylene liner. We found that polyethylene liner failure remains the main cause of revision of this modular cup. The main difference between our population of patients and other populations that have used this cup and liner is our population's cultural inclination toward squatting and leg crossing, body positions that increased the risk of impingement and eccentric wear.

Tests for the evaluation of ammonium attenuation in MSW landfill leachate by adsorption into bentonite in a landfill liner

Uncontrolled leachate emissions are one of the key factors in the environmental impact of municipal solid waste (MSW) landfills. The concentration of ammonium, given the anaerobic conditions in traditional landfills, can remain significantly high for a very long period of time, as degradation does not take place and volatilisation is not significant (the pH is not high enough to considerably shift the equilibrium towards un-ionised ammonia). Recent years have witnessed a continuous enhancement of landfill technology in order to minimize uncontrolled emissions into the environment; bottom lining systems have been improved and more attention has been devoted to the study of the attenuation of the different chemicals in leachate in case of migration through the mineral barrier. Different natural materials have been considered for use as components of landfill liners in the last years and tested in order to evaluate the performance of the different alternatives. Among those materials, bentonite is often used, coupled with other materials in two different ways: in addition to in situ soil or in geocomposite clay liner (GCL). A lab-scale test was carried out in order to further investigate the influence of bentonite on the attenuation of ammonium in leachate passing through a landfill liner. Two different tests were conducted: a standardized batch test with pulverized bentonite and a batch test with compacted bentonite. The latter was proposed in order to better simulate the real conditions in a landfill liner. The two tests produced values for the partition coefficient K d higher than the average measured for other natural materials usually utilized as components of landfill liners. Moreover, the two tests showed similar results, thus providing a further validation of the suitability of the standard batch test with pulverized bentonite. A thorough knowledge of attenuation processes of ammonium in landfill liners is the basis for the application of risk analysis models for the evaluation of the failure of bottom liners or their components.

Failure Mode of Polyethylene Liner in Total Hip Arthroplasty with Harris-Galante II Acetabular Cup

Purpose: To assess the mode of a polyethylene liner failure in total hip replacement using a Harris-Galante II acetabular component. Materials and Methods: A retrospective review was performed and 128 consecutive primary total hip arthroplasties were analyzed in 111 patients who had a second-generation Harris-Galante cup. All patients were followed up for a minimum of five years, with a mean follow up of 7.4 years (range, 5 to 12.9 years). A total of 26 cups (20.2%) were revised at the time of the latest follow up. The medical records, radiographs, surgical notes, and retrieved components were analyzed in order to determine the precise causes of the revision. Results: Twenty-two cases (17.3%) were found to have experienced problems with the polyethylene liner. Three types of liner failure were identified; metallosis associated with polyethylene liner wear (14 cases), excessive wear without metallosis necessitating a revision (6 cases), and polyethylene liner dissociation without gross evidence of wear (2 cases). Conclusion: This study find that polyethylene liner failure is the main cause of the revision of this component. Early surgical intervention needs to be performed before fatal metal damage occurs in order to avoid metallosis, and severe bone stock damage in cases of excessive polyethylene wear.

FAILURE OF THE POLYETHYLENE LINEAR OF A BIPOLAR HIP PROSTHESIS RESULTING IN DEEP DEFECT AND IMPENDING FRACTURE OF THE NECK OF THE FEMORAL STEM COMPONENT

This paper reports a case involving failure of the polyethylene liner of a Mecron bipolar hip prosthesis with impingement of varus metal shell on the femoral stem neck resulting in deep defect and impending fracture of femoral stem components.

Locking mechanism failure in the Harris-Galante porous acetabular component associated with recurrent hip dislocation

In this review of longitudinal studies of the Harris-Galante porous acetabular component, 20% of all revisions were caused by failure of the polyethylene liner locking mechanism. We report 2 cases of locking mechanism failure in the Harris-Galante porous acetabular component presenting with recurrent dislocation. Broken tines from the acetabular locking mechanism were found embedded into the polyethylene liners in both cases. In a 79-year-old woman with recurrent dislocation, the polyethylene liner and femoral head were replaced, and the acetabular component was revised. In a 74-year-old man with chronic recurrent dislocation, the polyethylene liner and femoral head were replaced, but the acetabular component was preserved. Appropriate treatment for locking mechanism failure with a well-fixed acetabular component depends on many factors, and further long-term data are needed. Copyright 2002, Elsevier Science (USA). All rights reserved.

Abdominal cyst after early failure of polyethylene liner in total hip arthroplasty

We report a case in which the early failure of a polyethylene liner, coupled with a 32-mm CrCo ball head, caused pelvic cyst formation simulating an abdominal mass. The presence of the mass with inguinal swelling lead us to diagnosis liner failure, as shown by radiography. An extraperitoneal cyst surrounding the iliopsoas muscle from the lesser trochanter up to the lumbosacral junction was demonstrated with pre-operative computed tomography and sonography. The cyst contained fluid and many large particles of polyethylene debris. The liner and the head were substituted and the cyst was removed through a different abdominal approach. We hypothesize that debris falls out and concentrates along the iliopsoas muscle from the very beginning of wear, and then the muscle concentration forces pumped it along the muscle belly. From the histologic point of view, large polyethylene particles were observed in the removed tissue, and no major osteoclastic activation was found.

Containment landfills: the myth of sustainability

A number of major problems associated with the containment approach to landfill management are highlighted. The fundamental flaw in the strategy is that dry entombment of waste inhibits its degradation, so prolonging the activity of the waste and delaying, possibly for several decades, its stabilisation to an inert state. This, coupled with uncertainties as to the long-term durability of synthetic lining systems, increases the potential, for liner failure at some stage in the future whilst the waste is still active, leading to groundwater pollution by landfill leachate. Clay liners also pose problems as the smectite components of bentonite liners are subject to chemical interaction with landfill leachate, leading to a reduction in their swelling capacity and increase in hydraulic conductivity. Thus, their ability to perform a containment role diminishes with time. More critically, if diffusion rather than advection is the dominant contaminant migration mechanism, then no liner will be completely impermeable to pollutants and the containment strategy becomes untenable. There are other less obvious problems with the containment strategy. One is the tendency to place total reliance on artificial lining systems and pay little attention to local geological/hydrogeological conditions during selection of landfill sites. Based on the attitude that any site can be engineered for landfilling and that complete protection of groundwater can be effected by lining systems, negative geological characteristics of sites are being ignored. Furthermore, excessive costs in construction and operation of containment landfills necessitate that they are large scale operations (superdumps), with associated transfer facilities and transport costs, all of which add to overall waste management costs. Taken together with unpredictable post-closure maintenance and monitoring costs, possibly over several decades, the economics of the containment strategy becomes unsustainable. Such a high-cost, high-technology approach to landfill leachate management is generally beyond the financial and technological resources of the less wealthy nations, and places severe burdens on their economies. For instance, in third world countries with limited water resources, the need to preserve groundwater quality is paramount, so expensive containment strategies are adopted in the belief that they offer greatest protection to groundwater. A final indictment of the containment strategy is that in delaying degradation of waste, the present generations waste problems will be left for future generations to deal with. More cost-effective landfill management strategies take advantage of the natural hydrogeological characteristics and attenuation properties of the subsurface. The ‘dilute and disperse’ strategy employs the natural sorption and ion exchange properties of clay minerals, and it has been shown that in appropriate situations it is effective in attenuating landfill leachate and preventing pollution of water resources. Operated at sites with thick clay overburden sequences, using a permeable cap to maximise rainfall infiltration and a leachate collection system to control leachate migration, ‘dilute and disperse’ is a viable leachate management strategy. Hydraulic traps are relatively common hydrogeological situations where groundwater flow is towards the landfill, so effectively suppressing outwards advective flow of leachate. This approach is also best employed with a clay liner, taking advantage of the attenuation properties of clays to combat diffusive flow of contaminants. These strategies are likely to guarantee greater protection of groundwater in the long term.

Geomembrane liner defects—causes, frequency and avoidance

Defect-free geomembrane liners can be considered impermeable to most landfill leachates so the objective of installing a geomembrane liner without holes and one that will remain intact throughout its design life is usually of paramount importance. Various types of defects, including holes arising prior to, during and after installation, and the reasons for their occurrence are considered. Post-installation liner failure can occur from environmental stress cracking, downdrag stresses caused by settling waste, folds, scratches and cuts subjected to stress, and penetration by items of waste, among other causes. The frequency of holes, taken from published data and from previously unpublished records of over 100 sites in the UK, is considered. The relevance of early (1980s) published data on hole frequency to present practice is addressed. Properties of manufactured sheet and tests of particular relevance to defect avoidance including environmental stress crack resistance, frictional properties and effectiveness of protection materials are discussed, together with the importance of careful design by the landfill engineer. Discussion on means of avoiding defects during installation and placement of cover materials addresses the benefits of construction quality assurance, leak location surveys and the importance of post-installation protection.

Severe polyethylene wear in uncemented acetabular cup system components: A report of 5 cases

We report 5 cases of severe failure of the polyethylene liner at 4 to 7.4 years after uncemented anatomic medullary locking (AML) total hip arthroplasty, using the acetabular cup system (ACS). The mode of failure was by a combination of wear through to the metal backing and liner fracture. Four of the 5 cases were associated with a 32-mm head. The ACS design is flawed because of a lack of hemispherical geometry resulting in rim loading on a region of the liner that has the thinnest polyethylene. All patients with this type of implant should be monitored for evidence of excessive polyethylene wear.

Catastrophic failure of the acetabular component in a ceramic-polyethylene bearing total hip arthroplasty

Recent research in total hip arthroplasty has focused on attempts to decrease wear at the femoral head-acetabulum articulation, to limit the production of debris that is believed to lead to osteolysis and prosthetic loosening. The use of ceramic-on-polyethylene bearing surfaces has been reported to produce lower wear rates and therefore may increase the life expectancy of the joint arthroplasty. Problems with this bearing have been reported to be due to ceramic femoral head fracture. Reported here are 2 cases of catastrophic failure of total hip arthroplasties, involving a ceramic femoral head, caused by failure of the polyethylene acetabular liner, with subsequent penetration of the femoral head through the acetabular shell.

Sustainable Landfill—Possibility or Pipe-Dream?

Too often a sustainable landfill is described in terms of operational technique (e.g. bioreactor landfill or repository for pretreated waste) rather than the more appropriate goal of managing a landfill such that the environmental risk is acceptable. The technique that achieves the lowest risk landfill will vary according to a number of factors including the waste composition, climate and local geology/hydrogeology, and will vary from country to country, region to region, and site to site. A truly sustainable landfill is one in which the waste materials are safely assimilated into the surrounding environment, whether or not they have been treated by biological, thermal or other processes, and which manages gas-related problems so as to minimize the environmental impact. This is more likely to be achieved in containment landfills, but recognizing that liner failure will occur ultimately, and that in the long term, the escape of waste materials and their products of degradation is inevitable. Appropriate site selection, design and management is crucial to the attainment of more sustainable waste management. @ 1997 ISWA

SUSTAINABLE LANDFILL — POSSIBILITY OR PIPE-DREAM?

Too often a sustainable landfill is described in terms of operational technique (e.g. bioreactor landfill or repository for pretreated waste) rather than the more appropriate goal of managing a landfill such that the environmental risk is acceptable. The technique that achieves the lowest risk landfill will vary according to a number of factors including the waste composition, climate and local geology/hydrogeology, and will vary from country to country, region to region, and site to site. A truly sustainable landfill is one in which the waste materials are safely assimilated into the surrounding environment, whether or not they have been treated by biological, thermal or other processes, and which manages gas-related problems so as to minimize the environmental impact. This is more likely to be achieved in containment landfills, but recognizing that liner failure will occur ultimately, and that in the long term, the escape of waste materials and their products of degradation is inevitable. Appropriate site selection, design and management is crucial to the attainment of more sustainable waste management.