During the past two decades, most total hip arthroplasties were performed with metal or ceramic heads on conventional polyethylene, an articulation associated with wear and limited life expectancy. Wear is associated with acetabular osteolysis. Isolated liner exchange has become a common surgical intervention when the acetabular component remains well-fixed. The purpose of isolated liner exchange is to prevent loosening of the components secondary to osteolysis and catastrophic mechanical failure caused by bearing wear-through. Treatment options for polyethylene wear include observation (in the asymptomatic hip), liner exchange, and more extensive revision procedures. Patients frequently present with asymptomatic but substantial polyethylene wear with or without associated osteolysis, the treatment of which is controversial. Other areas of debate include complete acetabular component removal to allow bone grafting and placement of an improved bearing surface, reuse of modular mechanisms, cementation into well-fixed shells, and whether to use periacetabular bone grafting.
Dr. Lombardi is Clinical Associate Professor of Orthopaedics and Biomechanical Engineering, The Ohio State University, Columbus, OH. Dr. Berend is Associate, Joint Implant Surgeons, Inc, Columbus.
Dr. Lombardi or a member of his immediate family has stock or stock options held in and serves as a consultant to or is an employee of Biomet. Dr. Berend or a member of his immediate family has stock or stock options held in and serves as a consultant to or is an employee of Biomet.
Reprint requests: Dr. Lombardi, Joint Implant Surgeons, Inc, Suite 200, 7277 Smith's Mill Road, New Albany, OH 43054.
J Am Acad Orthop Surg 2008;16:243-248