Isolated Liner Exchange using the Anterolateral Approach Is Associated with a Low Risk of Dislocation

Authors of reports on the outcome of isolated liner exchange for osteolysis and wear have reported high dislocation rates. Twenty-six patients (27 hips) with a minimum of 2 years of followup had isolated liner exchange for wear and osteolysis done using the abductor splitting anterolateral approach. The mean followup was 41 months. The average age at time of surgery was 51 years. Preoperative Harris hip scores averaged 70, and increased to 82 at the most recent followup. We observed improvements in pain and functional scores. The average operating time was 82 minutes, and the average blood loss was 255 mL. Only three (12%) patients required transfusion. No components were rerevised for aseptic loosening, and one patient (one hip) had a dislocation (3.7%). Isolated liner exchange for osteolysis and wear done using the anterolateral approach has a lower risk of dislocation than previously reported and provides substantial improvements in pain, function, and Harris hip score. Level of Evidence: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

[1]  S. Odum,et al.  Early morbidity of modular exchange for polyethylene wear and osteolysis. , 2004, The Journal of arthroplasty.

[2]  P. Lachiewicz,et al.  Modular revision for recurrent dislocation of primary or revision total hip arthroplasty. , 2004, The Journal of arthroplasty.

[3]  M. Semlitsch,et al.  Massive wear of a steel ball head by ceramic fragments in the polyethylene acetabular cup after revision of a total hip prosthesis with fractured ceramic ball , 2004, Archives of Orthopaedic and Trauma Surgery.

[4]  H. Amstutz,et al.  Fate of cementless acetabular components retained during revision total hip arthroplasty. , 2003, The Journal of bone and joint surgery. American volume.

[5]  Harry E Rubash,et al.  Osteolysis of the pelvis: evaluation and treatment. , 2003, Clinical orthopaedics and related research.

[6]  Wayne G Paprosky,et al.  The early dislocation rate in primary total hip arthroplasty following the posterior approach with posterior soft-tissue repair. , 2003, The Journal of arthroplasty.

[7]  C. Engh,et al.  Dislocation after polyethylene liner exchange in total hip arthroplasty. , 2003, The Journal of arthroplasty.

[8]  F. Roudot-thoraval,et al.  Revision Total Hip Arthroplasty Performed After Fracture of a Ceramic Femoral Head: A Multicenter Survivorship Study , 2003, The Journal of bone and joint surgery. American volume.

[9]  R. Barrack,et al.  Dislocation After Total Hip Arthroplasty: Implant Design and Orientation , 2003, The Journal of the American Academy of Orthopaedic Surgeons.

[10]  Robert B Bourne,et al.  Surgical Approach, Abductor Function, and Total Hip Arthroplasty Dislocation , 2002, Clinical orthopaedics and related research.

[11]  T. Brown,et al.  Choices and Compromises in the Use of Small Head Sizes in Total Hip Arthroplasty , 2002, Clinical orthopaedics and related research.

[12]  J. Wenz,et al.  Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. , 2002, Orthopedics.

[13]  Michael A Mont,et al.  Cementation of a polyethylene liner into a metal shell. Factors related to mechanical stability. , 2002, The Journal of bone and joint surgery. American volume.

[14]  C. Engh,et al.  Polyethylene liner exchange for excessive wear and osteolysis. , 2002, The Journal of arthroplasty.

[15]  V. Tan,et al.  Independent contribution of elevated-rim acetabular liner and femoral head size to the stability of total hip implants. , 2002, The Journal of arthroplasty.

[16]  P. Beaulé,et al.  Jumbo Femoral Head for the Treatment of Recurrent Dislocation Following Total Hip Replacement , 2002, The Journal of bone and joint surgery. American volume.

[17]  R. Bourne,et al.  Instability in Primary Total Hip Arthroplasty With the Direct Lateral Approach , 2001, Clinical orthopaedics and related research.

[18]  Richard E. White,et al.  Effect of Posterior Capsular Repair on Early Dislocation in Primary Total Hip Replacement , 2001, Clinical orthopaedics and related research.

[19]  D. Pedersen,et al.  Prevention of Dislocation After Hip Arthroplasty: Lessons From Long-Term Followup , 2001, Clinical orthopaedics and related research.

[20]  C. Engh,et al.  Surgical Treatment of Pelvic Osteolysis , 2001, Clinical orthopaedics and related research.

[21]  W. McGann,et al.  Treatment of the unstable total hip arthroplasty using modularity, soft tissue, and allograft reconstruction. , 2001, The Journal of arthroplasty.

[22]  W M Goldstein,et al.  Prevalence of Dislocation After Total Hip Arthroplasty Through a Posterolateral Approach with Partial Capsulotomy and Capsulorrhaphy , 2001, The Journal of bone and joint surgery. American volume.

[23]  B. Masri,et al.  Treatment of hip instability. , 2001, The Orthopedic clinics of North America.

[24]  R. Barrack,et al.  The use of modularity in revision total hip replacement. , 2001, American journal of orthopedics.

[25]  D. Berry Unstable total hip arthroplasty: detailed overview. , 2001, Instructional course lectures.

[26]  Philip C. Noble,et al.  The Effect of Femoral Component Head Size on Posterior Dislocation of the Artificial Hip Joint* , 2000, The Journal of bone and joint surgery. American volume.

[27]  R. Uhl,et al.  A bench-top method for evaluating modular total hip component combinations. , 2000, American journal of orthopedics.

[28]  A. Lombardi,et al.  Dislocation after total hip arthroplasty using the anterolateral abductor split approach. , 1999, Clinical orthopaedics and related research.

[29]  D. D’Lima,et al.  Polyethylene Wear After Total Hip Arthroplasty: The Effect of a Modular Femoral Head with an Extended Flange-Reinforced Neck* , 1998, The Journal of bone and joint surgery. American volume.

[30]  S. Kelley,et al.  Relationship of Femoral Head and Acetabular Size to the Prevalence of Dislocation , 1998, Clinical orthopaedics and related research.

[31]  Robert Poss,et al.  Posterior Approach to Total Hip Replacement Using Enhanced Posterior Soft Tissue Repair , 1998, Clinical orthopaedics and related research.

[32]  T D Brown,et al.  A Finite Element Analysis of Factors Influencing Total Hip Dislocation , 1998, Clinical orthopaedics and related research.

[33]  T. Schmalzried,et al.  The Fate of Pelvic Osteolysis After Reoperation; No Recurrence With Lesional Treatment , 1998, Clinical orthopaedics and related research.

[34]  C. Engh,et al.  Treatment of Pelvic Osteolysis Associated with a Stable Acetabular Component Inserted without Cement as Part of a Total Hip Replacement* , 1997, The Journal of bone and joint surgery. American volume.

[35]  H. Amstutz,et al.  Tripolar hip replacement for recurrent prosthetic dislocation. , 1994, Clinical orthopaedics and related research.

[36]  A. Lombardi,et al.  Translateral surgical approach to the hip. The abductor muscle "split". , 1993, Clinical orthopaedics and related research.

[37]  A. Vicar,et al.  A Comparison of the Anterolateral, Transtrochanteric, and Posterior Surgical Approaches in Primary Total Hip Arthroplasty , 1984, Clinical orthopaedics and related research.

[38]  B F Morrey,et al.  Dislocations after total hip arthroplasty. , 1982, The Journal of bone and joint surgery. American volume.

[39]  I C Clarke,et al.  Prosthetic hip range of motion and impingement. The effects of head and neck geometry. , 1982, Clinical orthopaedics and related research.