title: Constrained liners in revision total hip arthroplasty: an overuse syndrome: in the affirmative.
abstract: Instability after primary and revision total hip arthroplasty continues to be problematic for the surgeon. The use of constrained liners, which use a locking mechanism to capture the femoral head, has increased to help manage this problem. Constrained liners, however, present problems with acetabular component loosening, dissociation of the liner/shell interface, failure by breakage, and excessive polyethylene wear. Rather than resort to constrained liners, our approach has been to restore joint stability with large-diameter femoral heads. The advantages are increased range of motion due to more favorable head/neck ratio, increased resistance to dislocation due to increased jump distance, and the avoidance of skirted femoral heads. With the addition of cross-linked polyethylene, the volumetric wear associated with large heads is much decreased and makes this a viable option today.
authors.affiliation: Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois 60190, USA.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Fricka
authors.forename: Amanda
authors.initials: A
authors.lastname: Marshall
authors.forename: Wayne G
authors.initials: WG
authors.lastname: Paprosky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies