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

Parkar, Asif; Sukeik, Mohamed; El‐Bakoury, Ahmed; Powell, James

doi:10.1051/sicotj/2019025

Cited by 6 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surface roughness increases contact stress and scratches from the cyclic relative motion of patients during activities; the cyclic motion inflicts mechanical damages to the surface of the head-tapper junction/ neck-body junction and accelerates the rate of particle release within surrounding tissues [12]. Metal ions can be generated not only at the junction between the femoral head and socket, but also at the head and stem of femoral components, and the junction between modular components in MoP [33]. Contact surfaces can also create crevices at the modular implant interface which can lead to corrosion.…”

Section: Modular Designmentioning

confidence: 99%

The Mechanism of Metallosis After Total Hip Arthroplasty

Ude

Esdaille

Ogueri

et al. 2021

Regen. Eng. Transl. Med.

View full text Add to dashboard Cite

Metallosis is defined as the accumulation and deposition of metallic particles secondary to abnormal wear from prosthetic implants that may be visualized as abnormal macroscopic staining of periprosthetic soft tissues. This phenomenon occurs secondary to the release of metal ions and particles from metal-on-metal hip implants in patients with end-stage osteoarthritis. Ions and particles shed from implants can lead to local inflammation of surrounding tissue and less commonly, very rare systemic manifestations may occur in various organ systems. With the incidence of total hip arthroplasty increasing as well as rates of revisions due to prosthesis failure from previous metal-on-metal implants, metallosis has become an important area of research. Bodily fluids are electrochemically active and react with biomedical implants. Particles, especially cobalt and chromium, are released from implants as they abrade against one another into the surrounding tissues. The body’s normal defense mechanism becomes activated, which can elicit a cascade of events, leading to inflammation of the immediate surrounding tissues and eventually implant failure. In this review, various mechanisms of metallosis are explored. Focus was placed on the atomic and molecular makeup of medical implants, the component/surgical associated factors, cellular responses, wear, tribocorrosion, joint loading, and fluid pressure associated with implantation. Current treatment guidelines for failed implants include revision surgery. An alternative treatment could be chelation therapy, which may drive future studies. Lay Summary Arthroplasty is an invasive procedure which disrupts surrounding joint tissues, and can greatly perturb the joint’s immune homeostasis. In some instances, this may pose a difficult challenge to implant integration. Particles released from implants into the surrounding joint tissues activate the body’s defense mechanism, eliciting a cascade of events, which leads to biotribocorrosion and electrochemical attacks on the implant. This process may lead to the release of even more particles. Besides, implant makeup and designs, frictions between bearing surfaces, corrosion of non-moving parts with modular junctions, surgical mistakes, patient factor, comorbidities, and loosened components can alter the expected function of implants. High accumulations of these ions and particulates result in metallosis, with accompanying adverse complications. Current recommended treatment for failed prosthesis is revision surgeries. However, chelation therapy as a prophylactic intervention may be useful in future efforts but more investigation is required.

show abstract

Section: Modular Designmentioning

confidence: 99%

The Mechanism of Metallosis After Total Hip Arthroplasty

Ude

Esdaille

Ogueri

et al. 2021

Regen. Eng. Transl. Med.

View full text Add to dashboard Cite

show abstract

“…We are aware of only one case report with the R3 cup that occurred after a fall in a 56-year-old man 5 years after a complex primary hip replacement [19]. However, a further case report of liner dissociation leading to catastrophic failure of an oxinium head appears to be an R3 shell [20].…”

Section: Discussionmentioning

confidence: 99%

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

Gwynne‐Jones

Memon

2020

Arthroplasty Today

View full text Add to dashboard Cite

Background: There 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. Methods: This is a single-center retrospective study of 961 primary total hip arthroplasties using 2 thirdgeneration 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. Results: There 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 ¼ .024 to 0.038). The 7-year survival for all-cause revision was 96.1% for Pinnacle and 99.0% for R3 (P ¼ .022), and that in the acetabular reoperation group was 96.9% for Pinnacle and 99.3% for R3 (P ¼ .035). Conclusions: There 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.

show abstract

“…Polyethylene acetabular dissociation is a rare but known complication 12,13 . This can occur early in the postoperative period likely from incomplete locking of the liner into the shell or later from neck impingement damaging the locking mechanism 14,15 .…”

Section: Discussionmentioning

confidence: 99%

Liner Dissociation and Acetabular Erosion Treated by Implant Retention and Dual-Mobility Liner Cementation

Nabet

Sax

Nace

et al. 2022

JBJS Case Connector

View full text Add to dashboard Cite

Case: A 56-year-old woman underwent a left total hip arthroplasty (THA) after developing avascular necrosis after chemotherapeutic treatment of breast cancer. She presented approximately 2 years after index THA with left groin pain and complaints of instability. Imaging revealed pseudodislocation of the ceramic femoral head with erosion through the acetabular component. Intraoperative evaluation revealed a dissociated polyethylene liner, damaged acetabular locking mechanism, metallosis, and well-fixed and aligned components. Treatment consisted of component retention, bone grafting, and dual-mobility liner cementation into the acetabular component. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B906).

show abstract

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

Cited by 6 publications

References 13 publications

The Mechanism of Metallosis After Total Hip Arthroplasty

The Mechanism of Metallosis After Total Hip Arthroplasty

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

Liner Dissociation and Acetabular Erosion Treated by Implant Retention and Dual-Mobility Liner Cementation

Contact Info

Product

Resources

About