Wear-through of metal-backed acetabular shell in total hip arthroplasty.

Full-thickness wear-through of the metal-backed acetabular shell after total hip arthroplasty is unlikely in patients who receive adequate follow-up after operation. We report such a case that occurred after neglect of a dislodged polyethylene liner from the cup of a total hip prosthesis. The patient was a 71-year-old retired male laborer with a 40-year history of alcohol dependence that may have contributed to the decline in his condition. During a period of almost 7 years, clinical findings such as clicking sound, leg length shortening, eccentric position of the femoral head relative to the acetabular shell, and metallic mark in the polyethylene liner had been identified on radiographic examination. However, delayed recognition of the clinical importance of these findings resulted in full thickness wear-through and subsequent bony deficiency.