PMC8516556_01
X-ray after primary total hip replacement (1975).
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fig1
Due to increasing arthritis, the hip was replaced in 1975 implanting a collared cemented monoblock stem (Sheehan-Howmedica) with a nominal 22.225 mm head and a cemented PE cup (Figure 1).
X-ray prior to the second revision showing major osteolysis of the greater trochanter due to PE insert wear (a) (2009); situation after the second revision surgery, in which the greater trochanter was bone grafted, screws were removed, and a 36 mm PE liner was cemented into the uncemented cup (b) (2012).
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fig2
In 2010, the PE cup liner was revised due to major osteolysis of the greater trochanter (Figure 2).
X-ray prior to the third revision surgery (2020).
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fig3
These findings led to a third revision (Figure 3).
X-ray after the third revision surgery (2020).
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fig4
The monoblock stem was revised to a cemented Weber stem (size F 80) (Figure 4).
Explanted cup liner (a), bipolar head (b) with a constraining ring (c), and the monoblock stem (d).
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fig5
Avantage cup (Zimmer Biomet, Warsaw, USA; size 50) in combination with a 28 mm ceramic head (M) was cemented into the still well-fixed uncemented Harris-Galante cup from the primary implantation, which was the only component maintained during revision (Figure 5). Additionally, a synovectomy, arthrolysis, necrectomy, and scar excision were performed. The stem exhibited polished areas close to the tip of the stem indicating some movement in the cement mantle (Figure 5(d)).
Disassembled PE liner of the bipolar head (a) with signs of stem impingement around the opening (b); a 22.225 mm (nominal diameter) sphere fitted into the cross section in the supposed unworn position (c); imprinting of the bipolar head metal surface on the bottom, indicating cold flow of the PE (d).
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fig6
At the pole, the bipolar inner PE liner was worn down to a thickness of only 1 mm (Figure 6(c)). The device identification markings on the inside of the bipolar metal surface were imprinted into the bottom of the PE liner (Figure 6(d)). The rim of the PE head liner showed signs of stem impingement (Figure 6(b)).
(a) View of the articulating surface of the PE cup liner with multidirectional scratches and (b) pitting magnification of the local surface damage.
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fig7
The articulating surface of the cup liner showed scratches and pitting throughout without extended polished areas indicative of relative movement and wear (Figure 7).
(a) Heavily scratched area of the head with (b) magnification of the local surface damage.
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fig8
The articulating head showed a roughened area (Figure 8).
Deviation from a perfect sphere of the PE contact area of the cup liner (a) (d = 35.936 mm) and the head liner (b) (d = 22.070 mm). Red areas indicate PE wear, and blue areas indicate deposit.
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fig9