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Pinnacle polyethylene liner dissociation: a report of 3 cases.

ABSTRACT: We describe 3 cases of DePuy Pinnacle polyethylene dissociations, their presentations, and treatment. A 34-year-old female with arthritis secondary to dysplasia, a 51-year-old male with avascular necrosis of the femoral head, and a 57-year-old female with osteoarthritis were treated with total hip arthroplasty. Acute nontraumatic polyethylene liner dissociations occurred at 31, 42, and 2 months postoperatively. They were treated with component retention and modular femoral head and liner revision. The 51-year-old male subsequently developed a prosthetic joint infection requiring explant of his components. Although dissociation of polyethylene liners from the DePuy Pinnacle acetabular components is an uncommon complication, this problem may increase in prevalence with longer term follow-up, and vigilance is recommended.

SUBMITTER: Kagan R

PROVIDER: S-EPMC6287959 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Pinnacle polyethylene liner dissociation: a report of 3 cases.

Kagan Ryland R Anderson Mike B MB Peters Christopher C Pelt Christopher C Gililland Jeremy J

Arthroplasty today 20180911 4

We describe 3 cases of DePuy Pinnacle polyethylene dissociations, their presentations, and treatment. A 34-year-old female with arthritis secondary to dysplasia, a 51-year-old male with avascular necrosis of the femoral head, and a 57-year-old female with osteoarthritis were treated with total hip arthroplasty. Acute nontraumatic polyethylene liner dissociations occurred at 31, 42, and 2 months postoperatively. They were treated with component retention and modular femoral head and liner revisio ...[more]

PMID: 30569007

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

Project description:Between 2007 and 2018, 535 total hip arthroplasties using the uncemented Pinnacle acetabular component (DePuy Synthes, Warsaw, IN) and polyethylene liner were implanted in our unit. Of these, 6 patients presented acutely with liner polyethylene dissociation, giving a rate of liner dissociation of 1.11%. All dissociations were atraumatic. Failure occurred at mean 37 months (range 4.5 to 130 months). Radiologically, all acetabular components were within safe zone of abduction and mean anteversion was 10 degrees (range 2-20). In one case, there was posterior impingement against the femoral neck due to femoral malalignment. All patients underwent head and liner exchange with no repeat failures. Despite excellent long-term results, the frequency of dissociated polyethylene liners is a cause of concern with the Pinnacle acetabular component.

| S-EPMC7083726 | biostudies-literature

Computer simulation of optimal lipped polyethylene liner orientation against prosthetic impingement.

Project description:BackgroundLipped or elevated acetabular liners are to improve posterior stability and are widely used in hip arthroplasty. However, concerns of increasing impingement exist when using such liners and optimal orientation of the elevated rim remains unknown. We aimed to identify the impact of lipped liner on the range of motion (ROM) before impingement and propose its optimal orientation.MethodsAn isochoric three-dimensional model of a general hip-replacement prosthesis was generated, and flex-extension, add-abduction and axial rotation were simulated on a computer. The maximum ROM of the hip was measured before the neck impinged on the liner. Different combinations of acetabular anteversion angles ranging from 5 to 30 degrees, and lipped liner orientations from posterior to anterior were tested.ResultsWhen acetabular anteversion was 10 or 15 degrees, placing the lip of the liner in the posterosuperior of the acetabulum allowed satisfactory ROM in all directions. When acetabular anteversion was 20 degrees, extension and external rotation were restricted. Adjusting the lip to the superior restored satisfactory ROM. When acetabular anteversion was 25 degrees, only placing the lip into the anterosuperior could increase extension and external rotation to maintain satisfactory ROM.ConclusionsThis study showed that optimal lipped liner orientation should depend on acetabular anteversion. When acetabular anteversion was smaller than 20 degrees, placing lip in the posterior allowed an optimally ROM. When acetabular anteversion was greater than 20 degrees, adjusting lip to the anterior allowed a comprehensive larger ROM to avoid early impingement.

| S-EPMC8981617 | biostudies-literature

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Project description: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.

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| S-EPMC6470327 | biostudies-literature

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

Project description: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 third-generation 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 = .024 to 0.038). The 7-year survival for all-cause revision was 96.1% for Pinnacle and 99.0% for R3 (P = .022), and that in the acetabular reoperation group was 96.9% for Pinnacle and 99.3% for R3 (P = .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.

| S-EPMC7298534 | biostudies-literature

Intraprosthetic Dislocation of a Modular Dual-Mobility Total Hip Arthroplasty With Posterior Migration of the Polyethylene Liner.

Project description:Dual-mobility (DM) implants have been used in total hip arthroplasty since 1974. Modular DM implants have seen an increase in use in primary and revision total hip arthroplasties given the theoretical decreased dislocation rate. DM constructs have 2 articulation sites, one between the acetabular shell and a polyethylene liner, as well as one between the liner and the femoral head component. However, dislocations with modular DM implant dislocations can still occur. These dislocations occur via an extraprosthetic or intraprosthetic mechanism. Intraprosthetic dislocation is a phenomenon in which the smaller femoral head dissociates from the polyethylene liner. We present a case of intraprosthetic dislocation in an 81-year-old female with migration of the polyethylene liner into her gluteal muscles after 2 attempted closed reductions.

| S-EPMC10827604 | biostudies-literature

Two Cases of Polyethylene Granuloma After Distal Femoral Endoprosthesis With All-Polyethylene Tibia.

Project description:Limited literature exists on complications specific to the all-polyethylene tibial component in distal femoral replacement (DFR). Unlike in primary arthroplasty with polyethylene components, polyethylene granuloma has not been reported in DFR with an all-polyethylene tibia. Here, we report 2 cases of polyethylene granuloma in patients with primary bone sarcoma who underwent DFR with an all-polyethylene tibia. Radiologically, evidence of intraosseous granuloma formation and periprosthetic osteolysis was observed at the anterior tibial metaphysis. Both patients underwent an operative debridement of polyethylene granuloma and necrotic tissues, followed by a revision to a long-stem, cemented metal-backed tibia with impacted allograft to fill the defect. Polyethylene granuloma should be considered a differential diagnosis in the presence of a periprosthetic lytic lesion after DFR with an all-polyethylene tibial component.

| S-EPMC7851358 | biostudies-literature

Cause analysis of the liner dissociation of a customized reverse shoulder prosthesis based on finite element analysis.

Project description:Background: Dissociation of the polyethylene liner after reverse shoulder arthroplasty could cause shoulder dislocation that could not achieve closed reduction. The cause of liner dissociation is currently unclear. Method: Non-homogeneous model of the bone was constructed and dynamic finite element analysis was utilized to simulate the impingement of the polyethylene liner and scapula during humeral adduction. The stress distribution of the fixation claws, their degree of deformation (DOD), and the stress of the impingement sites in three initial humeral postures (neutral, 30° flexion, and 30° extension) were measured and analyzed. The influence of the liner material stiffness was also investigated. Result: The impingement stress on the liner and scapula was 100-200 MPa, and different humeral postures caused different locations of impingement points. The fixation claws' maximum principal stress (MPS) results were below 5 MPa. In the connection area between some fixation claws and the liner, compressive stresses on the inside and tensile stresses on the outside were observed, which showed that the fixation claws were prone to deform toward the center direction. The maximum DOD results of three initial humeral postures (neutral, 30° flexion, and 30° extension) were 3.6%, 2.8%, and 3.5%, respectively. The maximum DOD results of neutral initial humeral posture were 0.51% and 11.4% when the elastic modulus of the liner was increased and decreased by a factor of 10, respectively. Conclusion: The humeral adduction impingement could lead to the deformation of the claw-shaped liner fixation structure, which might be one of the reasons for the liner dissociation. The increased stiffness of the liner material helped to reduce the deformation of the fixation structure.

| S-EPMC9755191 | biostudies-literature

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

Project description:ObjectiveTo compare the wear of conventional ultra-high molecular weight polyethylene (CUHMWPE) and highly cross-linked polyethylene (HCLPE) in hip revision with liner exchange fixed with original locking mechanism using analysis of history medical data.MethodsFrom Jan. 1, 2000, to Dec. 31, 2007, 26 patients (with 29 involved hips) underwent liner exchange revision fixed with the original locking mechanism due to wear of CUHMWPE and/or osteolysis. The mean age was 53 ± 9 years at the time of the primary total hip arthroplasty (THA) and 64 ± 9 years at the revision. The exchanged liners (Marathon, Depuy) were made of HCLPE. Annual X-rays were used to measure linear wear and osteolysis. The annual linear penetration was measured using PolyWare® software (Draftware Inc.). Annual Harris Hip Scores(HSS) were recorded.ResultsThe mean follow-up time between the primary and revision THAs was 11 ± 2 years and 8 ± 2 years after revision. The mean Harris Hip Score(HHS) before primary THA, 1 year after primary THA, before revision and 1 year after revision was 43±5, 85±5, 71±6, 83±7 individually. The mean penetration of the CUHMWPE and HCLPE liners occurring in the first year were 0.44 ± 0.28 mm and 0.38 ± 0.14 mm, respectively (p = 0.211). The mean annual linear penetration of CUHMWPE and HCLPE from the second year onward were 0.29±0.09 mm and 0.08 ± 0.03 mm respectively (p <0.01). All THAs with CUHMWPE showed osteolysis on acetabular and/or femoral side before revision. No HCLPE liner showed osteolysis at the last follow-up. Conclusion: The CUHMWPE liner had a significantly higher wear rate than did the HCLPE liner. The HCLPE liner showed a satisfactory liner penetration rate after revision with isolated liner exchange fixed with the original locking mechanism.

| S-EPMC5147919 | biostudies-literature

Study of the Failure Mechanism of a High-Density Polyethylene Liner in a Type IV High-Pressure Storage Tank.

Project description:The use of Type IV cylinders for gas storage is becoming more widespread in various sectors, especially in transportation, owing to the lightweight nature of this type of cylinder, which is composed of a polymeric liner that exerts a barrier effect and an outer composite material shell that primarily imparts mechanical strength. In this work, the failure analysis of an HDPE liner in a Type IV cylinder for high-pressure storage was carried out. The breakdown occurred during a cyclic pressure test at room temperature and manifested in the hemispherical head area, as cracks perpendicular to the liner pinch-off line. The failed sample was thoroughly investigated and its characteristics were compared with those of other liners at different stages of production of a Type IV cylinder (blow molding, curing of the composite material). An examination of the liner showed that no significant chemical and morphological changes occurred during the production cycle of a Type IV cylinder that could justify the liner rupture, and that the most likely cause of failure was a design-related fatigue phenomenon.

| S-EPMC10975935 | biostudies-literature

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