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Case Reports
. 2024 Aug;14(8):71-75.
doi: 10.13107/jocr.2024.v14.i08.4650.

Eccentric Wear of Polyethylene Liner in a Bipolar Hemiarthroplasty Leading to a Revision Total Hip Arthroplasty

Sreedhar Archik  1 , Dhruva Angachekar  1 , Jeetendra Kataria  1 , Swastik Nakade  1
Affiliations
Case Reports

Eccentric Wear of Polyethylene Liner in a Bipolar Hemiarthroplasty Leading to a Revision Total Hip Arthroplasty

Sreedhar Archik et al. J Orthop Case Rep. 2024 Aug.

Abstract

Introduction: Aseptic component loosening is a common cause of revision surgery post a hip replacement surgery. Polyethylene wear is a known cause of this loosening which results due to osteolysis of the bone stock surrounding the implant. Most patients have catastrophic wear through failure which manifests as discomfort, noise in the joint, and eccentric femoral head location with increasing leg length discrepancy. However, sometimes clinical presentation may be quite late while liner erosion leads to subluxation of the femoral head which is seen on radiographic imaging. We present a case of rapid polyethylene liner wear leading to femoral head subluxation in a case of bipolar hemiarthroplasty of the hip.

Case report: A 70-year-old female patient underwent a bipolar hemiarthroplasty of the right hip for a transcervical neck of femur fracture 5 years ago. She presented to us with a subluxated femoral head within the cup on radiographs with clinical limp and pain. She was taken up for revision total hip replacement surgery.

Conclusion: Routine clinical and radiographic follow-ups should be done post-total or hemi hip replacement surgeries to catch polyethylene wear signs and symptoms in the early stage which could then be treated with a simple liner exchange rather than an extensive revision surgery. Whenever dealing with osteoporotic bone, we need to keep a low threshold for extended trochanteric osteotomy for cement removal from the femoral canal.

Keywords: Hip arthroplasty; extended trochanteric osteotomy; polyethylene liner wear; revision surgery.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Anteroposterior radiograph showing severe peritrochanteric osteolysis surrounding cemented bipolar hemiprosthesis.
Figure 2
Figure 2
Lateral radiograph showing acentric position of the femoral within the bipolar cup marked by the arrow.
Figure 3
Figure 3
Implants after removal showing polyethylene liner wear in the cup (marked by arrow) and the femoral stem.
Figure 4
Figure 4
Anteroposterior post-operative radiograph.
See this image and copyright information in PMC

References

    1. Learmonth ID, Young C, Rorabeck C. The operation of the century:Total hip replacement. Lancet. 2007;370:1508–19. - PubMed
    1. Kurcz B, Lyons J, Sayeed Z, Anoushiravani AA, Iorio R. Osteolysis as it pertains to total hip arthroplasty. Orthop Clin North Am. 2018;49:419–35. - PubMed
    1. Urban JA, Garvin KL, Boese CK, Bryson L, Pedersen DR, Callaghan JJ, et al. Ceramic-on-polyethylene bearing surfaces in total hip arthroplasty. Seventeen to twenty-one-year results. J Bone Joint Surg Am. 2001;83:1688–94. - PubMed
    1. Gosling OB, Ferreri TG, Khoshbin A, Whitehouse MR, Atrey A. A systematic review and meta-analysis of survivorship and wear rates of metal and ceramic heads articulating with polyethylene liners in total hip arthroplasty. Hip Int. 2020;30:761–74. - PubMed
    1. Ries MD. Complications in primary total hip arthroplasty:Avoidance and management:Wear. Instr Course Lect. 2003;52:257–65. - PubMed

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