title: Cementing a liner into a stable cementless acetabular shell: the double-socket technique.
abstract: BACKGROUND
  During revision hip replacement surgery, the cementless acetabular shell is often well fixed but the locking mechanism may be ineffective. Cementing a new liner into the existing acetabular shell (the double-socket technique) can provide a simple solution. The purposes of the present study were to review our initial clinical results and to define the potential limitations of this technique.
  
  
  METHODS
  Thirty-two hips with a preexisting well-fixed acetabular socket that had been in situ for an average of 8.6 years were treated with the insertion of a new polyethylene liner (seventeen hips) or a metal liner (fifteen hips) with use of cement. The indication for this technique was a deficient locking mechanism in twenty-two hips and the unavailability of a matching liner in ten hips. Anteroposterior radiographs of all hips were analyzed by a single independent reviewer.
  
  
  RESULTS
  The mean duration of follow-up was 5.1 years. Six hips required a reoperation after a mean of 29.7 months; the reasons for the reoperations included aseptic failure of the acetabular construct (four hips), instability (one hip), and sepsis (one hip). The University of California at Los Angeles hip scores improved significantly (p < 0.001) compared with the preoperative values; specifically, the mean score improved from 6.2 to 9.1 for pain, from 6.3 to 8.3 for walking, from 6.2 to 7.8 for function, and from 4.7 to 5.8 for activity. The prevalence of dislocation was 22%. Kaplan-Meier analysis with revision as the end point revealed a five-year survival rate of 78% (95% confidence interval, 55% to 91%).
  
  
  CONCLUSIONS
  The double-socket technique is a good alternative to acetabular socket removal for suitable candidates who have a well-fixed cementless socket with an inner diameter that is larger than the outer diameter of the cemented liner. This technique preserves acetabular bone stock and permits conversion to alternate bearing surfaces. We believe, however, that removal of a well-fixed acetabular shell or the use of a constrained liner should be strongly considered for patients with a history of hip instability.
authors.affiliation: Joint Replacement Institute, Orthopaedic Hospital/University of California at Los Angeles, Los Angeles, CA 90007, USA. pbeaule@laoh.ucla.edu
authors.forename: Paul E
authors.initials: PE
authors.lastname: Beaulé
authors.forename: Edward
authors.initials: E
authors.lastname: Ebramzadeh
authors.forename: Michel
authors.initials: M
authors.lastname: Le Duff
authors.forename: Rajiv
authors.initials: R
authors.lastname: Prasad
authors.forename: Harlan C
authors.initials: HC
authors.lastname: Amstutz
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001672:Biocompatible Materials / Q000627:therapeutic use; D001843:Bone Cements; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020959:Polyethylene / Q000627:therapeutic use; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D001843:Bone Cements; D020959:Polyethylene