Polyethylene liner dissociation with the Pinnacle acetabular component: should we be concerned?

Memon, Adeel R.; Gwynne‐Jones, David

doi:10.1016/j.artd.2019.12.001

Cited by 12 publications

(22 citation statements)

References 19 publications

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“…There have been multiple case reports and series of dissociations with the Pinnacle cup [6][7][8][9][10][11]17]. These can be early (within 2 years) or late (2 to 10 years) [10,11]. The rate of liner dissociation with the Pinnacle system is reported to be very low at between 0.17% and 0.8%, but it may be under-reported particularly in registry studies [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Other reasons suggested for dissociation may include malposition of the shell, use of face changing liners, impingement, polyethylene fatigue, and rim fracture with thin polyethylene and larger heads [6,7,10,11,[22][23][24]. There were no cases of cup malposition in those patients who dissociated.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequently used are the Pinnacle cup (DePuy Synthes, Warsaw, IN) and the R3 cup (Smith and Nephew, Memphis, TN), which were introduced around the same time and have a similar design. We have previously reported a series of liner dissociations with the Pinnacle cup from our unit and concluded that although some cases could be attributable to technical issues such as incomplete seating, impingement, and malalignment, the increasing numbers reported, including late dissociations, and the lack of reports with other systems suggested a problem with the locking mechanism [11]. The rate of liner dissociation is reported to be very low [6,7,12], but it may be underreported particularly in registry studies [6].…”

Section: Introductionmentioning

confidence: 91%

“…There were 6 liner dissociations (1.12%). All had previously been identified and detailed in our case series [11]. The mean time to presentation with dissociation was 37 months (range: 4.5 months to 10.8 years), with 4 of 6 presenting within 13 months of the initial procedure.…”

Section: Group 1 (Pinnacle)mentioning

confidence: 99%

“…Improvements in locking mechanisms had almost eliminated this problem. However, the problem has reemerged with the development of third-generation acetabular components [6][7][8][9][10][11]. These cups have been designed to accept multiple liner options and use a taper lock mechanism with no locking ring.…”

Section: Introductionmentioning

confidence: 99%

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

Gwynne‐Jones

Memon

2020

Arthroplasty Today

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 91%

Section: Group 1 (Pinnacle)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Gwynne‐Jones

Memon

2020

Arthroplasty Today

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

Sofia,

Ethiraj,

Nikolova

2023

Polymer Engineering & Sci

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Total hip arthroplasty (THA) involves the replacement of damaged or worn‐out hip components with artificial implants. Frequently revision surgeries were performed due to the failure of the implant. The liners are the ones that are replaced in the majority of the revision surgeries. Researchers are constantly finding different materials to overcome the difficulties being faced. The acetabular liners are fabricated by compression molding and milling using single materials such as Polyethylene, Polyether–ether–ketone (PEEK), and recently Ultra‐High Molecular Weight Polyethylene (UHMWPE), and so forth. Poly Lactic Acid (PLA) being biocompatible and cheaper than UHMWPE is employed in the research. The biodegradable nature of PLA is countered by introducing a nonbiodegradable yet biocompatible High Impact Polystyrene (HIPS). This research attempts to propose and fabricate a novel design of the liner with PLA sandwiched between HIPS by fused filament fabrication, the widely used additive manufacturing technique. The dimensional accuracy and surface roughness of the liners are measured and compared with single‐material liners. The multi‐material liner demonstrated superior dimensional accuracy compared to PLA liner and also exhibiting a smoother surface finish. Dynamic Mechanical Analysis is conducted to determine the capability of printing and also the scanning electron microscopic (SEM) images are used for supporting the results.Highlights Novel design of Acetabular Liner. Use of additive manufacturing for fabrication of implant parts. More than one material used to reap benefits from the two materials used. Measurement of dimensional accuracy, surface roughness of multi‐material liner. Comparison of single and multi‐material liner.

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Dissociation of liner from cup in THA: does liner damage affect the risk of dissociation?

Beckmann

Schonhoff

Bastian

et al. 2022

Arch Orthop Trauma Surg

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Introduction A rare catastrophic failure of modular component Total Hip Arthroplasty is dissociation between liner and cup, which has been associated with component malposition and/or impingement and seems to be more frequently associated with the Pinnacle system. The goal of this study was to evaluate the resistance of a polyethylene liner to lever-out-forces of the Pinnacle locking mechanism and the locking mechanisms of two other current cup/liner systems using a standardized testing method (ASTM). Materials and methods Five of each of the following cups were evaluated with their corresponding polyethylene liners: Pinnacle Multihole cup with and without intact anti-rotation tabs (ART’s); Allofit-S-Alloclassic and Plasmafit Plus7 cups. The ASTM test set-up was used to evaluate the lever-out force resulting in liner dissociation for each construct. Results The Pinnacle construct with intact ARTs required the greatest force (F) to achieve dissociation (263.2 ± 79.2 N) followed by the Plasmafit Plus7 (185.8 ± 36.9 N) and the Allofit-S (101.4 ± 35.3 N) constructs, respectively. However, after removal of the ARTs, the Pinnacle system required the least force to achieve dissociation (75.1 ± 22.2 N) (p < 0.001). Conclusions The intact Pinnacle system appeared the most stable in lever-out tests when compared to the other systems. However, after removal of the ARTs, the Pinnacle system required the least force for dissociation, consistent with locking mechanism failure, and suggesting that the ARTs are a critical component of the locking mechanism. Our findings are consistent with the clinical experience of dissociated Pinnacle constructs displaying damaged or missing ARTs, and that damage to these may increase risk of liner dissociation.

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Polyethylene liner dissociation with the Pinnacle acetabular component: should we be concerned?

Cited by 12 publications

References 19 publications

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

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

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

Dissociation of liner from cup in THA: does liner damage affect the risk of dissociation?

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