As the number of primary total hip arthroplasties increases, so does the burden of revision procedures. The decision to revise well-fixed components in the setting of polyethylene wear and osteolysis is controversial. Modular head and liner exchange offers the advantages of reduced invasiveness, faster recovery, and bone preservation. These advantages come at the expense of higher rates of revision surgery for instability. Using the native locking mechanism for securing the new liner is preferred; however, cementing a liner into a well-fixed acetabular component is a practical alternative. The use of bone allograft or bone graft substitute for areas of osteolysis is controversial. In the setting of osteolysis, outcomes associated with the use of highly cross-linked polyethylene liners have been better than those associated with the use of conventional polyethylene; therefore, thinner liners and larger femoral heads can be used and reduce the risk of instability.
From the Division of Orthopaedic Surgery, Department of Surgery, Southlake Regional Health Centre, Newmarket, Ontario, Canada (Dr. Walmsley), the Division of Orthopaedic Surgery, Department of Surgery, St. Michael’s Hospital, Toronto, Ontario, Canada (Dr. Waddell), and the Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, London, Ontario, Canada (Dr. Schemitsch).
Dr. Waddell or an immediate family member serves as a paid consultant to Smith & Nephew and Stryker and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Smith & Nephew and Stryker. Dr. Schemitsch or an immediate family member has received royalties from Stryker; serves as a paid consultant to Acumed, Amgen, Celgene, Kuros Biosciences, Sanofi-Aventis, Smith & Nephew, Stryker, and Wright Medical Technology; has received research or institutional support from Smith & Nephew; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from the Canadian Institutes of Health Research, OMeGA Medical Grants Association, Smith & Nephew, Stryker, DePuy Synthes, and Zimmer Biomet; and serves as a board member, owner, officer, or committee member of the Canadian Orthopaedic Association, the Orthopaedic Trauma Association, and the Osteosynthesis and Trauma Care Foundation. Neither Dr. Walmsley nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.
Received March 17, 2015
Accepted November 28, 2015