Midterm Survivorship of the Lefèvre Constrained Liner: A Consecutive Multisurgeon Series of 166 Cases

Abstract

Background: Constrained liners are used as part of a salvage procedure to provide stability for patients at high risk for dislocation after a total hip arthroplasty. However, no recent studies exist highlighting their effectiveness and/or limitations.

Method: This prospective review included 166 consecutive hip arthroplasties, either primary (27%) or revision (73%), with a unique design of a constrained liner: Lefèvre retentive cup. There were 113 females (69%), and the average age at index surgery was 75.9 years (range, 35-94). The mean follow-up was 6.2 years (range, 0.3-11).

Results: Twenty patients had a reoperation; 10 for infection (4 acute and 6 chronic joint infection) and 10 for cup failure (5 fixation failure, 3 aseptic loosening, and 2 dislocation). Ten-year survivals for cup revision were 89% (CI, 83-94) and 92% (CI, 89-97) for all revision and revision for noninfectious reasons, respectively. When solely evaluating for dislocation, the survival at 10 years was 99% (CI, 97-100). Considering primary and revision cases, 10-year survivals cup revision for aseptic reasons were 92.4% (CI, 84-100) and 92.5% (CI, 87-98), respectively.

Conclusions: The Lefèvre retentive cup demonstrated excellent 10-year's survivorship. With the rate of aseptic loosening around 2% and a dislocation rate around 1%, the cup is as effective as other available devices and is therefore a cost-effective tool to reduce the risk of dislocation in at-risk patients undergoing hip arthroplasty.

Keywords: Dual mobility cup; constrained liner; dislocation; hip arthroplasty; survivorship.