Modern polyethylene components for total hip arthroplasty have shown excellent long-term wear properties. However, among 204 primary total hip arthroplasty procedures performed by one surgeon using the Exactech Connexion GXL Liner, we identified 5 cases of severe polyethylene wear and osteolysis which occurred within 5 years of the index surgery. Among the 5 cases, all patients had a size 36 head with an acetabular component from size 52 to 56 mm. All patients had a UCLA activity scale score of at least 6 at the time that the osteolysis was detected. The average wear rate was 0.265 mm ± 0.207 mm per year. This review of 5 cases of catastrophic early polyethylene wear demonstrates a concerning trend with the use of the Exactech Connexion GXL liner. Further investigation is warranted to evaluate material characteristics which may have caused this accelerated wear and to prevent recurrences of this complication in the future.
Periprosthetic fracture can create significant morbidity in the arthroplasty population. Patients with periprosthetic fracture have been shown to have worse outcomes and higher mortality than patients undergoing elective revision THA. In this review, we will focus on Vancouver B2 and B3 fractures. Both of these fracture types are associated with a loose primary prosthesis and warrant revision surgery. There are many different options for fixation choice of the femoral prosthesis, and preference has been evolving over the last 30 years. Currently, we use monoblock, tapered, fluted, titanium stems for all periprosthetic fracture revision surgeries.
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