Acetabular Component and Liner Selection for the Prevention of Dislocation After Primary Total Hip Arthroplasty

Abstract

Primary total hip arthroplasty (THA) is a reproducible and efficacious procedure for patients with end-stage osteoarthritis; however, dislocation remains the most common cause of revision arthroplasty.Technological advancements in acetabular component design and liner options, in conjunction with a more comprehensive understanding of the spinopelvic factors that influence dislocation, will likely reduce the risk of dislocation and revision over time.The contemporary liner and shell options for primary THA, in order of increasing constraint and stability, include (1) neutral, (2) lateralized, (3) face-changing (oblique), (4) lipped (high-wall) with or without lateralization, (5) modular and anatomic dual-mobility, and (6) constrained options.Different liner designs can alter functional anteversion, inclination, and jump distance, and can be used to minimize a single predictable dislocation vector (lipped [high-wall] liners) or multiple vectors of instability risk when the dislocation direction is unpredictable (dual-mobility liners).Liner selection should be based on the patient-specific risk of dislocation, including static anatomic (e.g., large anterior inferior iliac spine or greater trochanter morphology), dynamic anatomic (e.g., limited sitting-standing change in the sacral slope), and demographic or medical (e.g., neurocognitive disorders and obesity) risk factors.

Instability in Total Hip Arthroplasty

“…A neutral liner should be used when the surgeon is satisfied with the acetabular position, the hip stability, and in instances where the patient has no increased risk of dislocation. This liner allows the patient to have the greatest range of motion since the implant will sit flush with the acetabular component but does not give the surgeon any added stability [113]. Some surgeons prefer to use a "lipped or high walled liner" to allow for increased stability due to a larger jump distance in a discrete quadrant (Figure 6).…”

“…Surgeons should be aware that these liners are not indicated in situations with implant malposition or hip impingement. The primary indication for these constraint liners is neuromuscular disorders, abductor deficiency or intraoperative multidirectional instability without hip impingement or implant malposition [113]. This increased constraint is commonly used in more difficult hips and has been shown to have higher revision rates from several mechanisms of failure [120].…”

A novel method of fabricating multi‐material acetabular liner using fused filament fabrication

“…The acetabular liner is a component of the THA prosthesis that is inserted into the acetabular cup. The liner serves as a cushion between the femoral head and acetabular cup 1,2 . In the past, liners made of Cobalt–Chromium alloy were found to release metal ions due to corrosion, as Hothi et al 3 reported.…”

Quantifying 30 Years of Technological Innovation in Total Hip Arthroplasty

“…Two of the most prominent examples of such recent technological innovations in THA include (1) technology-assisted THA that leverages precision of component placement from patient-specific images or robotic-assisted guides, [4][5][6][7][8] and (2) the development of dual mobility acetabular components with multiple points of articulation that provide increased range of motion and the potential for decreased risk of prosthetic dislocation. [9][10][11][12][13] However, focus turned toward the adoption of few major technologies may subtract from the attention that other laudable technological achievements in THA ultimately gain, and it is imperative to objectively assess progress in THA to guide current and future practice.…”