Document Detail

Isolated polyethylene exchange versus acetabular revision for polyethylene wear.
MedLine Citation:
PMID:  18846409     Owner:  NLM     Status:  MEDLINE    
Polyethylene wear and osteolysis are not uncommon in THA mid- and long-term. In asymptomatic patients the dilemma faced by the orthopaedic surgeon is whether to revise the cup and risk damage to the supporting columns and even pelvic discontinuity or to perform isolated polyethylene exchange and risk a high rate of postoperative recurrent instability and dislocation that will necessitate further surgery. We retrospectively reviewed 62 patients (67 hips) who underwent revision arthroplasty for polywear and osteolysis. Thirty-six hips had isolated polyethylene exchange, while 31 had full acetabular revision. The minimum followup was 2 years (mean, 2.8 years; range, 2-5 years). Three of 36 hips with a retained cup grafted through the cup holes failed within 5 years due to acetabular loosening. One of 31 hips with full revision underwent re-revision for aseptic cup loosening at 5 months postoperatively. Although we do not recommend prophylactic revision of all cups for polywear and osteolysis, the patient may be warned of the possibility of an approximate 10% failure rate when retaining the acetabular component. We do, however, advocate cup extraction in the following situations: damage to the locking mechanism, erosion of the femoral head through the liner and into the cup damaging the metal, and a malpositioned component that may jeopardize the stability of the revision. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Camilo Restrepo; Elie Ghanem; Carrie Houssock; Mathew Austin; Javad Parvizi; William J Hozack
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-10-10
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  467     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-16     Completed Date:  2009-01-16     Revised Date:  2010-09-21    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  194-8     Citation Subset:  AIM; IM    
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, PA 19107, USA.
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MeSH Terms
Acetabulum / surgery*
Aged, 80 and over
Arthritis, Rheumatoid / surgery
Arthroplasty, Replacement, Hip / adverse effects,  methods*
Bone Transplantation
Femur Head Necrosis / surgery
Follow-Up Studies
Hip Dislocation, Congenital / surgery
Hip Injuries / surgery
Hip Prosthesis*
Middle Aged
Osteoarthritis, Hip / surgery*
Postoperative Complications / surgery*
Prosthesis Failure
Retrospective Studies
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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