Polyethylene Liner Dissociation Research Articles

Polyethylene liner dissociation from humeral tray: impediment to closed reduction of dislocated reverse total shoulder replacement

Instability is one of the leading causes of revision for reverse total shoulder arthroplasty (RTSA). Closed reduction (CR) of a dislocated RTSA is recommended by many as initial treatment with varying degrees of success. In this study, we describe polyethylene liner dissociation from the humeral tray (PDH) as a cause of failure of CR of dislocated RTSA. In this retrospective study, patients who underwent revision RTSA for instability were identified through our institutional database review using specific International Classification of Diseases and Current Procedural Terminology codes. Pertinent clinical information including demographics, details of instability event (early vs. late), traumatic vs. atraumatic, outcomes of CR (if performed), and intraoperative findings during revision surgery were collected and analyzed. Twenty-two patients met the inclusion criteria with average follow-up of 2 years. CR was attempted in 12 (55%) patients, prior to revision surgery, and was successful in 5 (23%) patients. During the revision surgery polyethylene liner dissociation from the humeral tray (PDH) was identified in 10 patients (45%). Five of these 10 patients had failed CR and the other 5 patients did not undergo CR due to primary surgeon's preference. All patients with PDH event had onlay humeral tray RTSA system. Although not a consistent radiographic finding in our series, the presence of the metallic glenosphere in direct contact with the humeral tray on anteroposterior or axillary radiographs was diagnostic for PDH. Dissociation of polyethylene liner from the humeral tray can be associated with an RTSA dislocation and is a contraindication for CR. A radiographic finding of the metallic humeral tray articulating directly with the glenosphere is an indication that the polyethylene liner is dissociated from the humeral tray.

Polyethylene Liner Dissociation in the Early Post-Operative Period Following Total Hip Arthroplasty: A Case Report and Literature Review

Polyethylene liner dissociation (PLD) is a rare but catastrophic complication following total hip arthroplasty (THA). When it occurs in the early postoperative period, it can be easy to miss the diagnosis. Liner dissociation has been reported previously with the Pinnacle® (DePuy), Harris-Galante® (Zimmer), and Trident® (Stryker) acetabular components. To the best of our knowledge, this is the first case reporting PLD in the G7® cup (Zimmer-Biomet). This case report, along with a review of the literature, highlights the clinical presentation, radiological imaging, treatment options, and technical tips to avoid PLD in the early postoperative period.

Acetabular Liner Dissociation: A Comparative Study of Two Contemporary Uncemented Acetabular Components.

BackgroundThere are a number of reports of polyethylene liner dissociation of third-generation modular acetabular components. This study compares our experience with 2 contemporary systems to determine whether this is an implant- or class-specific problem.MethodsThis is a single-center retrospective study of 961 primary total hip arthroplasties using 2 third-generation modular cementless acetabular shells: Pinnacle (535) and R3 (426) with a polyethylene liner. Details of all revisions were obtained from local databases and the New Zealand Joint Registry. Kaplan-Meier survival curves were calculated for all-cause revision, acetabular reoperation (including liner exchange), and liner dissociation.ResultsThere were 17 revisions in group 1 (Pinnacle; DePuy Synthes): 17 for recurrent dislocation, 6 for liner dissociations (1.12%), 3 for femoral loosening, and one for deep infection. In group 2 (R3; Smith and Nephew), there were 4 revision procedures: one for infection, 2 for dislocation, and one femoral revision for periprosthetic fracture. There were significantly higher proportions revised in group 1 for all-cause revision, acetabular reoperation, and dissociation (P = .024 to 0.038). The 7-year survival for all-cause revision was 96.1% for Pinnacle and 99.0% for R3 (P = .022), and that in the acetabular reoperation group was 96.9% for Pinnacle and 99.3% for R3 (P = .035).ConclusionsThere was a higher revision rate for the Pinnacle acetabular component than for the R3 at 7 years. This was mainly due to polyethylene liner dissociation that can occur early or late. It appears to be a problem specific to the Pinnacle cup design rather than a feature of similar third-generation acetabular components.

Imaging evaluation of polyethylene liner dissociation in total hip arthroplasty.

To describe the imaging findings of polyethylene liner dissociation in total hip arthroplasty. Retrospective search of our institution's radiology database identified 12 patients with polyethylene liner dissociation of a total hip arthroplasty. Clinical and operative notes were reviewed. All radiological studies were reviewed independently by two radiologists. Among 12 patients (seven females/five males; mean age: 67years; median interval after surgery at diagnosis: 8.5months) with polyethylene liner dissociation, 11 had radiographs, six had CT, seven had MRI, and two had arthrography. "Bubble sign" and "crescent sign" on radiography were insensitive, seen only in three patients, but all showed abrupt eccentric positioning of the femoral head. CT identified the dislocated liner in five of six patients but failed to identify one liner, which was partially associated with the acetabular cup. MRI identified the dislocated liner in all seven patients, with the MAVRIC (multiacquisition variable resonance image combination) sequences either increasing the diagnostic confidence relative to the routine pulse sequences or being the sole sequences in which the liner can be identified if the liner remained partially associated with the acetabular cup. Arthrography identified the dislocated liner in one of two patients. Previously described radiographic signs of polyethylene liner dissociation are insensitive, but abrupt eccentric positioning of the femoral head in the correct clinical context is highly suggestive of the diagnosis. MRI and CT can accurately localize the displaced liner. MAVRIC is particularly helpful if the dislocated liner remains partially associated with the acetabular cup.

Acetabular liner dissociation: A case report and review of the literature

Dissociation of the polyethylene liner from the acetabular shell is a rare but catastrophic complication of total hip arthroplasty (THA). There have been reports of polyethylene liner dissociation (PLD) as well as ceramic liner dissociation (CLD) in the literature. Amongst the commonly used implants, liner dissociation has been reported with the Pinnacle (DePuy), Harris–Galante (Zimmer) and Trident (Stryker) acetabular components.To the best of our knowledge, this is the first case report of PLD in an R3 (Smith & Nephew) acetabular component. This case report highlights the implant choice for treatment of the liner dissociation and the role of constrained implants in such cases.

Polyethylene Liner Dissociation with the Depuy Pinnacle Cup: A Report of 6 Cases

This case report discusses six cases of liner dissociation with the Pinnacle acetabulum following primary total hip arthroplasty. Cases involved a 54mm, 55mm, 56mm or 58mm Pinnacle cup with a neutral polyethylene liner and a 28mm femoral head with either an uncemented Corail or cemented C-Stem femoral prosthesis. Liner dissociation occurred between six months and 19 months post-operatively and all cases occurred following hip flexion. Revision involved replacement of the dissociated liners with either a neutral or lipped liner (Pinnacle or Ultamet polyethylene or metal) and in four of the six cases the femoral head size was increased. In all six cases the dissociated liners were found to have three of the six peripheral locking tabs sheared off. We explore possible causes for liner dissociation.

Catastrophic failure of tripolar constrained liners due to backside wear: a novel failure mode

Constrained acetabular liners have been developed for patients who are at high risk for dislocation or who are undergoing revision surgery for recurrent dislocations. We report on 2 cases of failure of tripolar constrained liners due to severe backside polyethylene wear after dissociation of the outer polyethylene liner without dislocation, a mode of failure not previously reported. The backside of the inserts suffered severe polyethylene deformation, wear, and scratching due to dissociation from the locking mechanism. In patients with tripolar constrained liners, radiographic evidence of eccentric wear should be considered as possible occult dissociation of the polyethylene liner within the shell. Conversion to a modular dual mobility liner appears to be a viable solution in this setting.

Highly Cross-linked Polyethylene Liner Dissociation from a Cement-less Modular Acetabular Shell: Two Case Reports.

Liner dissociation of polyethylene from a cementless acetabular socket following total hip arthroplasty (THA) is a rare complication. Cross-linked polyethylene liner dissociation from AMS-HA shell (KYOCERA Med, Osaka, Japan) occurred in 2 out of the 4153 (0.04%) cases approximately 10 years after undergoing surgery at our institute. First case was an 80-year-old female who underwent right THA along with subtrochanteric femoral shortening osteotomy due to complete dislocation hip, and second case was a 72-year-old male, who underwent right THA due to coxarthrosis. A 26 mm femoral head and CPE liner were used in both cases and the inclination degree of the acetabular socket was within 50°.There was no implant loosening in both cases. There was partial damage in the elevated rim on the alternative side and scratches on the back side in the both extracted CPE liner. It was surmised that liner dissociation was caused due to a problem in the liner fixing format of the push in type of the present model.

Late polyethylene liner dissociation after cement-free hip joint replacement: A case report

Late polyethylene liner dissociation after cement-free hip joint replacement: A case report

Polyethylene Liner Dissociation Is a Complication of the DePuy Pinnacle Cup: A Report of 23 Cases

Polyethylene liner dissociation is a rare but catastrophic event in total hip arthroplasty (THA), and certain implant designs are known to be at greater risk. Although the DePuy Pinnacle (Warsaw, IN, USA) modular acetabular construct has an excellent record of fixation and wear, an unexpectedly high number of liner dissociations has been noted. The purposes of this study were (1) to characterize the clinical parameters observed in a large group of patients who have experienced liner dissociations with the DePuy Pinnacle acetabular component; (2) to describe the radiographic findings in this group of patients; and (3) to calculate a minimum frequency of this complication. Since 2001, 23 patients with previously well-functioning THAs presented with sudden atraumatic polyethylene liner dissociation at four separate institutions. These THAs were performed between 2001 and 2013. Eight different arthroplasty specialists had performed the index hip arthroplasties using the DePuy Pinnacle acetabular component with a polyethylene liner. Polyethylene failures were evaluated for liner type and radiographic cup position. For three of the surgeons who contributed cases, institutional registries allowed the calculation of the number of components of this type that they used during the period in question, which provided a conservative estimate of the frequency of this type of failure. All 23 liner failures occurred atraumatically in previously asymptomatic THAs at a mean of 48 months (range, 3-138 months). Patients characteristically reported a new and sudden onset of discomfort with audible, reproducible squeaking. Surgical inspection of dissociated liners demonstrated displacement of polyethylene with shearing of the peripheral locking tabs. Radiographic evaluation demonstrated that 14 cups were well positioned and nine cups were malpositioned outside the so-called safe zone. Conservative estimates of the frequency of this complication from the three surgeons' practices whose institutional registries allowed calculation of the lowest possible frequency were 0.32% (six of 1888), 0.77% (three of 391), and 0.82% (three of 367). With this report of 23 additional liner dissociations, we suggest that surgeons should be aware of the problem and take extra precautions when using this implant to ensure locking mechanism integrity at the time of surgery. We caution that the frequency of liner dissociation may be higher than previously reported. Level IV, therapeutic study.

The tram track sign: a characteristic sonographic feature of polyethylene liner dissociation after total-hip arthroplasty.

Polyethylene liner dissociation from an acetabular component is a complication of total-hip arthroplasty (THA) caused by slippage of the liner, which causes pain and requires a revision. The aim of this study was to evaluate sonographic features of liner dissociation and detect useful sonographic findings compared to conventional radiography and computed tomography (CT). Among a total of 226 patients who underwent revision THA at our institution between September 2008 and June 2012, 10 patients (6 male and 4 female; mean age, 56.2 years) who showed severe narrowing of the superior joint space on the THA side and underwent sonography were retrospectively reviewed by evaluating radiographic, CT, and sonographic findings. In evaluation of the images, we put more emphasis on the "radiographic crescent sign," "CT crescent sign," and "sonographic tram track sign." At surgery, 7 patients showed liner dissociation, and 3 showed severe liner wear. On radiography, 8 of 10 patients (80%) had a correct diagnosis of the presence or absence of liner dissociation; on sonography, all 10 patients (100%) had a correct diagnosis. The sensitivity, specificity, and accuracy for diagnosis of liner dissociation by pelvic radiography and sonography were 100% (7 of 7), 33% (1 of 3), and 80% (8 of 10) and 100% (7 of 7), 100% (3 of 3), and 100% (10 of 10), respectively. Liner dissociation can be easily and well visualized by sonography, especially compared to pelvic radiography and CT. The sonographic tram track sign should be a very useful feature in the early diagnosis of liner dissociation.

The Tram-Tract Sign: A Characteristic Feature of the Polyethylene Liner Dissociation in Total Hip Arthroplasty On Sonography

The Tram-Tract Sign: A Characteristic Feature of the Polyethylene Liner Dissociation in Total Hip Arthroplasty On Sonography

Four cases of dissociation of polyethylene liner with APR cup

Four cases of dissociation of polyethylene liner with APR cup

Sonographic Detection of Acetabular Polyethylene Liner Dissociation in Total Hip Arthroplasty

Journal of Ultrasound in MedicineVolume 28, Issue 11 p. 1597-1600 Case Report Sonographic Detection of Acetabular Polyethylene Liner Dissociation in Total Hip Arthroplasty Wook Jin MD, Corresponding Author Wook Jin MD [email protected] Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaAddress correspondence to Wook Jin, MD, Department of Radiology, East-West Neo Medical Center, 149 Sangil-dong, Kangdong-gu, Seoul 134-090, Korea.Search for more papers by this authorYoung Soo Chun MD, Young Soo Chun MD Department of Orthopedic Surgery, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorSo Young Park MD, So Young Park MD Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorKee Hyung Rhyu MD, Kee Hyung Rhyu MD Department of Orthopedic Surgery, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorJi Seon Park MD, Ji Seon Park MD Department of Radiology, Kyung-Hee Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorHyun Cheol Kim MD, Hyun Cheol Kim MD Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorDal Mo Yang MD, Dal Mo Yang MD Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorKyung Nam Ryu MD, Kyung Nam Ryu MD Department of Radiology, Kyung-Hee Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this author Wook Jin MD, Corresponding Author Wook Jin MD [email protected] Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaAddress correspondence to Wook Jin, MD, Department of Radiology, East-West Neo Medical Center, 149 Sangil-dong, Kangdong-gu, Seoul 134-090, Korea.Search for more papers by this authorYoung Soo Chun MD, Young Soo Chun MD Department of Orthopedic Surgery, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorSo Young Park MD, So Young Park MD Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorKee Hyung Rhyu MD, Kee Hyung Rhyu MD Department of Orthopedic Surgery, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorJi Seon Park MD, Ji Seon Park MD Department of Radiology, Kyung-Hee Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorHyun Cheol Kim MD, Hyun Cheol Kim MD Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorDal Mo Yang MD, Dal Mo Yang MD Department of Radiology, East-West Neo Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this authorKyung Nam Ryu MD, Kyung Nam Ryu MD Department of Radiology, Kyung-Hee Medical Center, College of Medicine, Kyung-Hee University, Seoul, KoreaSearch for more papers by this author First published: 01 November 2009 https://doi.org/10.7863/jum.2009.28.11.1597Citations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume28, Issue11November 2009Pages 1597-1600 RelatedInformation

The analysis of Affecting Factors for the Dissociation of the Polyethylene Liner in Cementless Harris-Galante Acetabular Component

The analysis of Affecting Factors for the Dissociation of the Polyethylene Liner in Cementless Harris-Galante Acetabular Component

Acetabular revisions using a cementless oblong cup: five to ten year results

The purpose of this paper was to evaluate the results of acetabular revisions with the use of an oblong revision cup that is designed with its longitudinal diameter elongated relative to its transverse diameter. Between 1996 and 2001, 62 hips in 60 patients underwent an acetabular revision with the insertion of a LOR acetabular component. Seven hips were lost to follow-up or the patients died; the remaining 55 hips (53 patients) remained in follow-up for an average of 7.2 years (range: 5.0-10.1 years). One socket was revised for aseptic loosening, and another was operated on for a late polyethylene liner dissociation. The average Harris hip score (HHS) improved from 34 to 79. Results were rated as excellent in 16 hips, good in 28, fair in six and poor in three. Radiographic analysis demonstrated an improvement in the average vertical displacement of the hip centre: 49 hips had a well-fixed, bone-ingrown cup and four had a stable fibrous union. For large superolateral acetabular bone deficiencies, this implant facilitated a complex reconstruction without the need for bulk structural acetabular bone grafts, provided good clinical results and showed satisfactory stability at the midterm follow-up.

Primary Cementless Acetabular Components in Hips with Severe Developmental Dysplasia or Total Dislocation

We previously reported the seven-year results of the use of a hemispherical, porous-coated acetabular component in twenty consecutive primary total hip arthroplasties in a highly selected group, namely, patients with severe developmental dysplasia or total dislocation of the hip. The present report describes the outcomes of those hips nine years later, at an average follow-up of sixteen years (range, 11.5 to nineteen years). Since the time of our prior report, two shells were revised; one revision was done because of aseptic loosening and the other, because of polyethylene liner dissociation without tine fracture. The remaining shells were well fixed. No pelvic osteolysis was evident on plain radiographs. The average polyethylene liner wear rate was 0.09 mm/yr. With failure defined as aseptic loosening of the shell, the average sixteen-year survival for the shell was 92%. We believe that this cup had excellent fixation at a long duration of follow-up of sixteen years in this highly selected set of patients with difficult hip problems. Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Revision Total Hip Arthroplasty in Hip Joints With Metallosis: A Single-Center Experience With 31 Cases

Clinical and radiographic findings of metallosis in relation to the clinical outcome of revision total hip arthroplasty were analyzed for 31 hips. Causes of metallosis were dissociation of polyethylene liner in 24 hips, catastrophic wear in 6, and the screw used for stem fixation in 1. Metallosis was grade I in 12 hips, grade II in 7, and grade III in 12. Osteolysis around the acetabular cup was observed in 24 (77.4%) of 31 hips. At the time of final follow-up evaluation, none of the hips showed osteolysis, acetabular cup migration, or any change in inclination. Although metallosis could not be completely eradicated in severe cases, the clinical outcome for these hips was favorable. This study demonstrates that metallosis frequently causes osteolysis and that complete elimination of it is not a prerequisite for the success of revision total hip arthroplasty.

The crescent sign: dissociation of the polyethylene liner from a modular acetabular component in total hip arthroplasty

To study whether there was a common pattern of clinical symptoms, signs and radiographic features for the dissociation of the polyethylene liner from an acetabular component and to postulate reasons for these features. Retrospective study of notes and radiographs of cases of revision hip arthroplasty for polyethylene liner dissociation of the cementless Harris-Galante I porous-coated acetabular component (Zimmer Inc, Warsaw, IN) at the Avon Orthopaedic Centre, Bristol, UK and St. Mary's Hospital, Bristol, UK between 1995 and 2004. Patients were contacted to confirm preoperative symptoms. Nine cases of late polyethylene liner dissociation of this prosthesis have been revised in these institutions. All patients presented with a reduction in mobility, groin pain and limp. Eight patients reported an audible noise on hip movement. In all cases, radiographs showed radiolucency medial to the femoral neck in association with an eccentrically placed femoral head showing contact with the acetabular metal shell, which we have termed the "crescent sign." There is a typical clinical presentation in this study. The diagnosis can be made from a single anteroposterior pelvic radiograph without the need for previous films for comparison, or the need for arthrography. Clinicians should look specifically for the crescent sign when an eccentrically placed femoral head has been noted, in order to differentiate the more unusual diagnosis of dissociation from that of polyethylene wear. Early revision surgery can prevent damage to the femoral head and metal acetabular shell, thus reducing the complexity of revision surgery.

Dissociation of the Harris-Galante II polyethylene liner in rheumatoid arthritis patients

We investigated the dissociation of polyethylene liner from the Harris-Galante II metal shell inarthritis patients with rheumatoid arthritis. A total of 41 total hip arthroplasties using Harris-Galante II cup in 34 patients were reviewed retrospectively. There were three cases with dissociation of the polyethylene liner and locking tine breakage of metal shell, and one case with locking tine breakage without dissociation of the polyethylene liner. In three cases with dissociation of the polyethylene liner, two cups had been placed relatively horizontally while the third had been placed relatively vertically. In general, high activity, heavy body weight, and young age are thought to be risk factors for polyethylene liner dissociation, but these patients generally have lower activity and lighter body weight compared to patients with osteoarthritis or avascular necrosis of the femoral head. The use of small femoral heads and either horizontal or vertical cup placement may have allowed impingement and tine damage, contributing to liner dissociation in these relatively inactive patients.