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

ABSTRACT: 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.

SUBMITTER: Memon AR

PROVIDER: S-EPMC7083726 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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

Memon Adeel R AR Gwynne-Jones David D

Arthroplasty today 20200109 1

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 ...[more]

PMID: 32211467

Similar Datasets

Pinnacle polyethylene liner dissociation: a report of 3 cases.

Project description: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.

| S-EPMC6287959 | biostudies-literature

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

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| S-EPMC7298534 | biostudies-literature

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| S-EPMC4564778 | biostudies-literature

Long-term results of uncemented acetabular cups with an ACS polyethylene liner. a 14-16-year follow-up study.

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| S-EPMC2267555 | biostudies-other

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

Project description:Cobalt metallosis after revision metal-on-polyethylene total hip arthroplasty for catastrophic failure of ceramic components is uncommon but a potentially devastating complication. Common findings associated with heavy metal toxicity include cardiomyopathy, hypothyroidism, skin rashes, visual disturbances, hearing changes, polycythemia, weakness, fatigue, cognitive deterioration, and neuropathy. We report a case of a 57-year-old woman who presented with complaints of progressively worsening hip pain, fatigue, memory loss, lower extremity sensory loss, persistent tachycardia, and ocular changes 5 years after synovectomy and revision of a failed ceramic-on-ceramic total hip arthroplasty to metal-on-polyethylene components. A cobalt level of 788.1 ppb and chromium level of 140 ppb were found on presentation and subsequently decreased to 468.8 ppb and 105.9 ppb, respectively, 2 weeks after revision to a ceramic-on-polyethylene total hip arthroplasty. Improvement of symptoms accompanied this decrease in cobalt and chromium levels. Revision of failed ceramic arthroplasties with later-generation ceramics to avoid this potential complication is recommended.

| S-EPMC4958112 | biostudies-literature

Acetabular polyethylene wear and acetabular inclination and femoral offset.

Project description:UNLABELLED: Restoration of femoral offset and acetabular inclination may have an effect on polyethylene (PE) wear in THA. We therefore assessed the effect of femoral offset and acetabular inclination (angle) on acetabular conventional (not highly cross-linked) PE wear in uncemented THA. We prospectively followed 43 uncemented THAs for a minimum of 49 months (mean, 64 months; range, 49-88 months). Radiographs were assessed for femoral offset, acetabular inclination, and conventional PE wear. The mean (+/- standard deviation) linear wear rate in all THAs was 0.14 mm/year (+/- 0.01 mm/year) and the mean volumetric wear rate was 53.1 mm(3)/year (+/- 5.5 mm(3)/year). In THAs with an acetabular angle less than 45 degrees , the mean wear was 0.12 mm/year (+/- 0.01 mm/year) compared with 0.18 mm/year (+/- 0.02 mm/year) in those with a reconstructed acetabular angle greater than 45 degrees . Reproduction of a reconstructed femoral offset to within 5 mm of the native femoral offset was associated with a reduction in conventional PE wear (0.12 mm/year versus 0.16 mm/year). Careful placement of the acetabular component to ensure an acetabular angle less than 45 degrees in the reconstructed hip allows for reduced conventional PE wear. LEVEL OF EVIDENCE: Level II, prospective study. See Guidelines for Authors for a complete description of levels of evidence.

| S-EPMC2758973 | biostudies-other

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.

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Liner dissociation leading to catastrophic failure of an Oxinium femoral head.

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Canted seating of the Stryker Modular Dual Mobility liner within a Trident hemispherical acetabular shell.

Project description:A 75-year-old woman who suffered a left femoral neck fracture underwent a left total hip arthroplasty using a Stryker Trident (Kalamazoo, MI) hemispherical acetabular shell and Modular Dual Mobility (MDM) metal liner. Post-operative radiographs demonstrated canted seating of the liner. The patient was taken immediately back to the operating room where the acetabular liner appeared well seated superiorly but was in a canted position inferiorly. Removal and replacement was performed and post-operative radiographs demonstrated complete seating. Subsequent follow up at 6 months demonstrated good clinical function with no adverse radiographic findings. Canted seating is a potential complication of the MDM metal liner. Providers should be aware of potential incomplete seating inferiorly despite the superior portion of the liner being well seated.

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