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      Pinnacle polyethylene liner dissociation: a report of 3 cases

      case-report

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          Abstract

          We describe 3 cases of DePuy Pinnacle polyethylene dissociations, their presentations, and treatment. A 34-year-old female with arthritis secondary to dysplasia, a 51-year-old male with avascular necrosis of the femoral head, and a 57-year-old female with osteoarthritis were treated with total hip arthroplasty. Acute nontraumatic polyethylene liner dissociations occurred at 31, 42, and 2 months postoperatively. They were treated with component retention and modular femoral head and liner revision. The 51-year-old male subsequently developed a prosthetic joint infection requiring explant of his components. Although dissociation of polyethylene liners from the DePuy Pinnacle acetabular components is an uncommon complication, this problem may increase in prevalence with longer term follow-up, and vigilance is recommended.

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          Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers.

          Klaus Siebenrock, D. F. Kalbermatten, R Ganz (2003)
          Pelvic inclination is difficult to control on a standard radiograph of the pelvis and has a direct influence on the appearance of acetabular version. By defining the normal range of the distance between the symphysis and the sacrococcygeal joint on 86 standard anteroposterior radiographs of pelves a technique was developed to evaluate pelvic inclination. A statistically significant correlation between this distance and pelvic inclination was shown in four cadaver pelves. Acetabular retroversion signs (cross-over, posterior wall signs) were evaluated on normal pelves from cadavers (two females, two males) after mounting on a holding device and wire marking of the acetabular rims. Radiographs were taken 3 degrees stepwise through the range of 9 degrees inclination to 12 degrees reclination. At the neutral position, two acetabula appeared with both positive retroversion signs compared with none at 6 degrees reclination. At 9 degrees pelvic inclination all acetabula had both signs. Retroversion signs were significantly more pronounced and found at lower pelvic tilt angles in the pelves from males than from females. Evaluation of pelvic inclination will help to decrease measurement errors in assessment of acetabular orientation and femoral head coverage. This will be valuable in preoperative planning of reorientation procedures.
          Article 0 comments Cited 100 times – based on 0 reviews     Review now
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            Dislocation after total hip arthroplasty: implant design and orientation.

            Robert Barrack (2015)
            Implant design and positioning are important factors in maintaining stability and minimizing dislocation after total hip arthroplasty. Although the advent of modular femoral stems and acetabular implants increased the number of head, neck, and liner designs, the features of recent designs can cause intra-articular prosthetic impingement within the arc of motion required for normal daily activities and thus lead to limited motion, increased wear, osteolysis, and subluxation or dislocation. Minimizing impingement involves avoiding skirted heads, matching a 22-mm head with an appropriate acetabular implant, maximizing the head-to-neck ratio, and, when possible, using a chamfered acetabular liner and a trapezoidal, rather than circular, neck cross-section. Computer modeling studies indicate the optimal cup position is 45 degrees to 55 degrees abduction. Angles <55 degrees require anteversion of 10 degrees to 20 degrees of both the stem and cup to minimize the risk of impingement and dislocation.
            Article 0 comments Cited 35 times – based on 0 reviews     Review now
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              Independent predictors of failure up to 7.5 years after 35 386 single-brand cementless total hip replacements: a retrospective cohort study using National Joint Registry data.

              S. Jameson, P N Baker, Jeffrey J Mason … (2013)
              The popularity of cementless total hip replacement (THR) has surpassed cemented THR in England and Wales. This retrospective cohort study records survival time to revision following primary cementless THR with the most common combination (accounting for almost a third of all cementless THRs), and explores risk factors independently associated with failure, using data from the National Joint Registry for England and Wales. Patients with osteoarthritis who had a DePuy Corail/Pinnacle THR implanted between the establishment of the registry in 2003 and 31 December 2010 were included within analyses. There were 35 386 procedures. Cox proportional hazard models were used to analyse the extent to which the risk of revision was related to patient, surgeon and implant covariates. The overall rate of revision at five years was 2.4% (99% confidence interval 2.02 to 2.79). In the final adjusted model, we found that the risk of revision was significantly higher in patients receiving metal-on-metal (MoM: hazard ratio (HR) 1.93, p < 0.001) and ceramic-on-ceramic bearings (CoC: HR 1.55, p = 0.003) compared with the best performing bearing (metal-on-polyethylene). The risk of revision was also greater for smaller femoral stems (sizes 8 to 10: HR 1.82, p < 0.001) compared with mid-range sizes. In a secondary analysis of only patients where body mass index (BMI) data were available (n = 17 166), BMI ≥ 30 kg/m(2) significantly increased the risk of revision (HR 1.55, p = 0.002). The influence of the bearing on the risk of revision remained significant (MoM: HR 2.19, p < 0.001; CoC: HR 2.09, p = 0.001). The risk of revision was independent of age, gender, head size and offset, shell, liner and stem type, and surgeon characteristics. We found significant differences in failure between bearing surfaces and femoral stem size after adjustment for a range of covariates in a large cohort of single-brand cementless THRs. In this study of procedures performed since 2003, hard bearings had significantly higher rates of revision, but we found no evidence that head size had an effect. Patient characteristics, such as BMI and American Society of Anesthesiologists grade, also influence the survival of cementless components.
              Article 0 comments Cited 25 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jeremy Gililland
                Journal
                Journal ID (nlm-ta): Arthroplast Today
                Journal ID (iso-abbrev): Arthroplast Today
                Title: Arthroplasty Today
                Publisher: Elsevier
                ISSN (Electronic): 2352-3441
                Publication date PMC-release: 11 September 2018
                Publication date Collection: December 2018
                Publication date (Electronic): 11 September 2018
                Volume: 4
                Issue: 4
                Pages: 441-446
                Affiliations
                [1]Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
                Author notes
                [∗ ]Corresponding author. Department of Orthopaedics, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108, USA. Tel.: +1 801 587 5410. jeremy.gililland@ 123456hsc.utah.edu
                Article
                Publisher ID: S2352-3441(18)30081-5
                DOI: 10.1016/j.artd.2018.08.001
                PMC ID: 6287959
                PubMed ID: 30569007
                SO-VID: e9e8637a-d0be-427e-b4e6-6174bdcc5115
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 4 June 2018
                Date revision received : 6 August 2018
                Date accepted : 8 August 2018
                Categories
                Subject: Case Report

                Keywords: modular acetabular components,polyethylene liner dissociation,depuy,pinnacle
                Data availability:
                Keywords: modular acetabular components, polyethylene liner dissociation, depuy, pinnacle

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