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Superior rim fracture of a vitamin E-infused highly cross-linked polyethylene (HXLPE) liner leading to total hip arthroplasty revision.

ABSTRACT: This case report looks at the failure of a vitamin E-infused highly cross-linked polyethylene acetabular liner that fractured at the superior rim of the locking mechanism. This calls to question whether there is a problem with the vitamin E-infused product or a flaw in the design of the liner or possibly a combination of the 2. Although there has been discussion of a possible minimum rim polyethylene thickness, there has not been a minimum thickness established. In addition, in the case of offset liners, indentations which are a part of a locking mechanism can cause the minimum rim dimension to be much less than the specified nominal thickness. This case serves as an interesting observation and contributes to the discussion of rim liner polyethylene thickness and minimum rim thickness.

SUBMITTER: Brazier BG

PROVIDER: S-EPMC6123179 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Superior rim fracture of a vitamin E-infused highly cross-linked polyethylene (HXLPE) liner leading to total hip arthroplasty revision.

Brazier Brett G BG Mesko J Wesley JW

Arthroplasty today 20180321 3

This case report looks at the failure of a vitamin E-infused highly cross-linked polyethylene acetabular liner that fractured at the superior rim of the locking mechanism. This calls to question whether there is a problem with the vitamin E-infused product or a flaw in the design of the liner or possibly a combination of the 2. Although there has been discussion of a possible minimum rim polyethylene thickness, there has not been a minimum thickness established. In addition, in the case of offse ...[more]

PMID: 30186906

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The prevalence of elevated-rim polyethylene liner use in primary total hip arthroplasty in the New York State metropolitan area.

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| S-EPMC6921167 | biostudies-literature

Ceramic liner fracture and impingement in total hip arthroplasty.

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| S-EPMC4342397 | biostudies-literature

A Simple Technique to Remove an Incarcerated Ceramic Liner in Revision Hip Arthroplasty.

Project description:Extraction of a well-fixed ceramic liner during revision total hip arthroplasty can be technically challenging, particularly when acetabular fixation screws prevent en bloc removal of the shell and insert without causing collateral damage to the adjacent pelvic bone. It is also important to remove the ceramic liner intact, as ceramic debris left in the joint may cause third body wear with premature articular wear of the revised implants. We describe a novel technique to extract an incarcerated ceramic liner when previously described strategies prove ineffective. Knowledge of this technique will help surgeons avoid unnecessary damage to the acetabular bone and optimize prospects for stable implantation of revision components.

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Cobalt toxicity after revision to a metal-on-polyethylene total hip arthroplasty for fracture of ceramic acetabular component.

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Incarcerated fracture fragments of Longevity polyethylene liners after total hip arthroplasty.

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Comparison of Polyethylene Wear before and after Hip Revision with Liner Exchange Fixed with the Original Locking Mechanism.

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Fracture of the insert cone of a polyethylene liner in a failed posterior-stabilized, rotating-platform total knee arthroplasty.

Project description:Failures unique to posterior cruciate-substituting total knee prostheses rarely include polyethylene post fractures but have been described. We report a case involving a fracture of the distal insert cone of a rotating-platform (RP) polyethylene liner in a primary total knee arthroplasty. This case highlights a 67-year-old male presenting with new-onset knee pain and recurrent effusions with osteolysis 11 years following placement of a posterior-stabilized, RP total knee arthroplasty. At the time of revision surgery, the polyethylene insert cone was found to be fractured just below the junction between cone and the body of the insert. Liner exchange, synovectomy, and osteolytic-defect curettage and cement packing were performed. One year following revision surgery, the patient is without pain and has returned to function without limitations. Clinicians must be aware of this possible failure with RP prostheses in the setting of pain with a stable knee, recurrent aseptic effusions, and osteolysis.

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Uncemented total hip arthroplasty; increased risk of early periprosthetic fracture requiring revision surgery in elderly females.

Project description:PurposeThe preferred method of stem fixation in total hip arthroplasty (THA) remains debatable. Uncemented THA favors a lower rate of aseptic loosening but has an increased risk of early periprosthetic fractures (EPF). We hypothesize that routine placement of uncemented THA by experienced surgeons diminishes this EPF-risk. The purpose of this study is to investigate the effect of age, gender, ASA classification and BMI of THA performed by experienced surgeons on the risk of EPF.MethodsA retrospective cohort study including all primary THAs and revision surgeries performed between 2012 and 2018. Possible predictive factors included are age, gender, BMI, ASA classification, presence of osteoporosis, Dorr classification, revision surgery type and clinical outcome. A number needed to treat (NNT) analysis was conducted assuming that cementing THA prevents EPF.Results2635 primary THAs were performed. Indications for 70 revisions included 18 EPF in uncemented THA female patients. Periprosthetic fractures without a relevant trauma occurred within six weeks in 16 patients. There was a statistically significant correlation between EPF-risk and age (P = 0.032), female gender (P = 0.001) and ASA classification (P = 0.015). For age ≥75, there was an increase in EPF (P = 0.047). With the assumption that cementing would prevent EPF, the NNT is 48. No statistically significant correlation was found between EPF and BMI, osteoporosis or Dorr classification.ConclusionFemale patients aged ≥75 have an increased EPF-risk after uncemented THA and would therefore benefit from treatment with a cemented stem. An ASA score of III-IV is an independent risk factor for EPF after uncemented THA.

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Late Breakage of a Dual-Mobility Polyethylene Insert in a Revision Total Hip Arthroplasty: An Unusual Failure Mode.

Project description:The use of dual-mobility cups has gained popularity in recent years. Thus, surgeons can expect an increase in known and new causes of failure. We report a previously undescribed form of a late intraprosthetic dislocation consisting of a complete breakage of a polyethylene mobile bearing that suffered a dislocation 3 months after its implantation. Two years later, he began feeling anterior groin pain and suffered gait changes. Computed tomography scan revealed an eccentric alignment of the mobile polyethylene bearing suggestive of poly wear. During the revision surgery, the polyethylene was found to be split in 2. Possible causes of this complication are proposed. Our case shows a previously unreported implant-specific complication, so surgeons can identify it.

| S-EPMC8551416 | biostudies-literature

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