CORR - 2026-03-25 - Journal Article
Minimum 10-year Results of Cementing a Polyethylene Liner Into an Acetabular Cup With a Deficient Locking Mechanism: Is It a Reliable Option?
Rhyu KH, Cho YJ, Chun YS, Lee MG
Topics
Key Takeaway
Cementing a polyethylene liner into Harris-Galante II shells yielded 77% survivorship free from acetabular cup revision at 15 years with a 39% overall complication rate.
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Summary
This study evaluated durability, patient-reported outcomes, and survivorship after cementing a highly crosslinked polyethylene liner into well-fixed Harris-Galante II shells with deficient locking mechanisms. Of 76 revision procedures performed between 2006–2015, 51 patients met inclusion criteria with minimum 10-year follow-up. Harris Hip Score improved from 74 to 88 (p<0.001) and WOMAC from 79 to 59 (p<0.001), but Kaplan-Meier survivorship free from acetabular revision was 88% at 10 years and 77% at 15 years, with complications in 39% of patients including dislocation, late cup loosening, new osteolysis, and periprosthetic fracture.
Key Limitation
Single cup design (Harris-Galante II) limits generalizability to other acetabular shell geometries with different locking mechanism architectures.
Original Abstract
BACKGROUND
Cementing a new liner into a well-fixed acetabular cup with a deficient locking mechanism has been reported as a viable option, but concerns remain regarding complications such as dislocation and late loosening.
QUESTIONS/PURPOSES
What were the (1) durability of the cement-liner interface, (2) patient-reported outcome scores and complications, and (3) survivorship free from revision after liner cementation into a single acetabular cup design (Harris-Galante II, Zimmer) when the cup's locking mechanism was found to be deficient?
METHODS
Between May 2006 and January 2015, two surgeons performed 76 revision procedures with retention of the metallic shell by cementing a new polyethylene liner into the existing shell. During that time, this procedure was used when the acetabular shell was well fixed but the locking mechanism was found to be deficient, or when a compatible liner was unavailable. When the native locking mechanism appeared intact, liner exchange was performed using the original locking mechanism without cementation. All patients treated with this procedure were considered potentially eligible for inclusion in this retrospective study. Of those, 9% (7 of 76) were excluded because they had a shell other than the Harris-Galante II cup, which was the focus of this study. An additional 16% (12 of 76) were lost prior to the minimum study follow-up of 10 years or had incomplete data sets, leaving 75% (57 of 76) for analysis. In patients who underwent bilateral procedures, the hip operated on first was selected for analysis to avoid nonindependence of observations, resulting in a final cohort of 51 patients. A highly crosslinked polyethylene liner was used in all procedures. The mean ± SD patient age at revision surgery was 57 ± 12 years, and the median (range) follow-up was 14 years (10 to 18), with all patients having a minimum 10-year follow-up. Fifty-one percent (26 of 51) of the patients were men. Clinical outcomes and complications were assessed using medical records and radiographs. Implant survivorship was estimated using the Kaplan-Meier method at 10 and 15 years with 95% confidence intervals (CIs), using acetabular cup revision as the endpoint.
RESULTS
The cement-liner interface remained intact throughout follow-up. The mean ± SD Harris hip score improved from 74 ± 21 to 88 ± 11 (p < 0.001), and the WOMAC score also improved from 79 ± 13 to 59 ± 14 (p < 0.001), whereas both the SF-12 mental and physical component summary scores did not improve. Complications occurred in 39% (20 of 51) of patients, including posterior dislocation, late cup loosening, new osteolysis, and periprosthetic femoral fracture. Kaplan-Meier survivorship free from acetabular cup revision was 88% (95% CI 80% to 98%) at 10 years and 77% (95% CI 66% to 90%) at 15 years.
CONCLUSION
The results of this study suggest that liner cementation into Harris-Galante II shells (Zimmer) resulted in frequent complications and lower survivorship than we expected, and given that 16% (12 of 76) of the patients were lost to follow-up, our findings may have underestimated the risk of complications. Therefore, surgeons should exercise caution when considering isolated liner cementation, particularly given the high rates of dislocation and late shell loosening, and patients should be counseled thoroughly regarding these risks.
LEVEL OF EVIDENCE
Level IV, therapeutic study.