title: Complete acetabular cup revision versus isolated liner exchange for polyethylene wear and osteolysis without loosening in cementless total hip arthroplasty.
abstract: BACKGROUND
  Revision surgery in patients showing polyethylene wear and acetabular osteolysis without visible acetabular cup loosening involves the difficult decision of whether to revise only the liner or both the cup and the liner. The purpose of this study is to compare the outcomes of complete acetabular revision and isolated liner exchange in patients showing wear and osteolysis without loosening.
  
  
  METHODS
  We evaluated 80 cases of revision surgery for polyethylene wear and osteolysis without cup loosening performed between October 1997 and December 2008. The cup revision group consisted of 45 patients who underwent a complete acetabular cup replacement, and the cup retention group consisted of 35 patients who underwent either an isolated liner exchange or a liner cementing procedure. Comparisons between the two groups were performed.
  
  
  RESULTS
  There were differences in femoral stem revision, estimated blood loss, and hospital stay. Other variables including complications, osteolysis progression, re-revision rate, clinical score, and satisfaction showed no differences between the two groups. There was one case of early loosening and subsequent re-revision surgery in the cup revision group, as well as one case of wear progression and liner dislodgement leading to complete re-revision of the acetabular component and femoral stem in the cup retention group.
  
  
  CONCLUSIONS
  We found no differences in acetabular osteolysis progression, fixation failure, or complication between the cup revision and retention groups. Therefore, isolated liner exchange without cup extraction in cases of osteolysis that includes a well-fixed and well-positioned shell could be considered as a viable treatment option.
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Kyoung Hwan
authors.initials: KH
authors.lastname: Koh
authors.forename: Young-Wan
authors.initials: YW
authors.lastname: Moon
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Lim
authors.forename: Hyun Il
authors.initials: HI
authors.lastname: Lee
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Shim
authors.forename: Youn-Soo
authors.initials: YS
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000601:surgery*; D020959:Polyethylene; D011183:Postoperative Complications / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D020959:Polyethylene