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. 2022 Dec;32(8):1459-1468.
doi: 10.1007/s00590-021-03130-w. Epub 2021 Oct 4.

Polyethylene liner cementation into a well-fixed metal acetabular shell for the management of periacetabular osteolysis: a systematic review

Michael-Alexander Malahias  1 , Qian-Li Ma  2 , Seong J Jang  3 , Marios Loucas  4 , Alex Gu  1   5 , Ioannis Gkiatas  1 , Jean-Claude Sedran  6 , Vasileios S Nikolaou  7 , Peter K Sculco  1
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Polyethylene liner cementation into a well-fixed metal acetabular shell for the management of periacetabular osteolysis: a systematic review

Michael-Alexander Malahias et al. Eur J Orthop Surg Traumatol. 2022 Dec.

Abstract

Purpose: Although various papers have reported on the clinical performance of cup retention with cementation of a new liner and bone grafting in the management of well-fixed cups with polyethylene wear and periacetabular osteolysis after total hip arthroplasty (THA), no systematic review of this topic has been published to date.

Methods: Medline, EMBASE and Cochrane Library were searched for articles published from January 1999 to January 2019 using "osteolysis" AND "well-fixed", "osteolysis" AND "retro-acetabular", "bone graft" AND ("retention" OR "retained" OR "stable") AND "cup", and "cemented liner" AND "well-fixed".

Results: Nine articles were selected for review (186 cases, 76.1 months mean follow-up). The overall revision rate was 11.3% (21 hips) most commonly due to aseptic loosening (9/186 hips), dislocation (8/186 hips), and liner wear progression (2/186 cases). The reported square size of osteolytic lesions ranged from a mean of 465.84 mm2 to a max of 4,770 mm2. Almost all reported lesions treated with bone grafts resolved or did not progress 97% (72/74). All studies indicated improved pain and functional scores at follow-up.

Conclusion: Cementation of a new liner with periacetabular bone grafting provides an alternative option to isolated liner exchange and cup revision for the management of periacetabular osteolysis in well-fixed cups with a disrupted locking mechanism or unavailable exchange liner. Further higher quality studies are required in order to examine if the use of highly cross-linked polyethylene, highly porous-coated cups, hydroxyapatite-coated cups, and small-diameter cups influence the clinical outcome of liner cementation in well-fixed cups with periacetabular osteolysis.

Keywords: Bone grafting; Cemented liner; Periacetabular osteolysis; Polyethylene liner; Systematic review; Well-fixed.

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