Cemented Constrained Liners Used as an Articulating Hip Spacer for the Treatment of Chronic Prosthetic Joint Infection

Abstract

Background: Two-stage exchange arthroplasty remains the gold standard for treating chronic hip periprosthetic joint infections. However, controversy remains regarding the optimal spacer type, particularly among patients with increased dislocation risk. This study reports on the outcomes of articulating hip spacers utilizing a single constrained-liner design.

Methods: All patients who underwent treatment for hip periprosthetic joint infection at a single institution were screened. Patients were included if they received an articulating spacer utilizing a constrained liner of a single manufacturer design. Indications for constrained liner, demographic variables, and surgical variables were recorded. Patients were assessed for dislocation and component loosening prior to the second stage or at the final follow-up if the second stage was not undertaken. Comparative analysis was performed.

Results: Overall, 26 constrained liners were utilized in 25 patients. Indications for constrained liner included history of dislocation (n = 14), massive proximal femoral bone loss (n = 14), greater trochanteric deficiency (n = 12), and absent abductors (n = 7). Many patients had more than one indication. In total, 9 hips (34.6%) underwent a second stage at an average of 7.4 months, while 17 hips never underwent a second stage with an average follow-up of 27.6 months. One patient experienced failure of their constrained liner prior to the second stage due to pelvic discontinuity and massive acetabular bone loss.

Conclusions: Utilization of a constrained liner as an articulating spacer is a viable option for patients at high risk of instability. Meticulous cement technique, appropriate component position, and implant selection are crucial in achieving successful outcomes.

Keywords: Articulating spacer; Constrained liner; Hip instability; Periprosthetic joint infection; Revision total hip arthroplasty.

Figure 1

(a) AP radiograph of the left hip taken prior to first-stage revision total hip arthroplasty, showing proximal femoral bone loss and greater trochanteric deficiency. (b) AP radiograph of the left hip taken following first-stage revision showing a constrained liner cemented in place. AP, anterior to posterior.

Figure 2

(a) AP radiograph of the left hip taken prior to first-stage revision total hip arthroplasty showing a constrained liner. (b) AP radiograph of the left hip taken immediately following first-stage revision, showing a constrained liner cemented in place. (c) AP radiograph of the left hip taken at 6-month follow-up. AP, anterior to posterior.

Figure 3

(a) AP radiograph of the right hip taken prior to first-stage revision total hip arthroplasty showing constrained liner. (b) AP radiograph of the right hip taken immediately following first-stage revision, showing a constrained liner cemented in place. (c) AP radiograph of the right hip taken at a 3-year follow-up. AP, anterior to posterior.

Figure 4

(a) AP radiograph of the right hip taken following a previous revision total hip arthroplasty. (b) AP radiograph of the right hip taken immediately following an additional first-stage revision showing a constrained liner cemented in place. (c) AP radiograph of the right hip taken showing a periprosthetic greater trochanteric fracture. AP radiograph of the right hip taken following open reduction and internal fixation of the periprosthetic fracture. (d) The femoral component was revised, while the femoral head and acetabular components remained intact. (e) AP radiograph of the right hip taken 1 year postoperatively from image d. (f) AP radiograph of the right hip taken at 55 months following initial constrained liner placement. AP, anterior to posterior.

Figure 5

(a) AP radiograph of the left hip taken prior to first-stage revision total hip arthroplasty, showing a complex total hip arthroplasty. (b) AP radiograph of the left hip taken immediately following first-stage revision, showing a constrained liner cemented in place. (c) AP radiograph of the left hip taken at 1 month postoperatively, showing loosening of the constrained liner. (d) AP radiograph of the left hip following definitive reconstruction. AP, anterior to posterior.