Kunze Kyle N, Premkumar Ajay, Bovonratwet Patawut, Sculco Peter K
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
JBJS Rev. 2021 Dec 15;9(12):01874474-202112000-00004. doi: e21.00148.
»: Primary total hip arthroplasty (THA) is a reproducible and efficacious procedure for patients with end-stage osteoarthritis; however, dislocation remains the most common cause of revision arthroplasty.
»: Technological advancements in acetabular component design and liner options, in conjunction with a more comprehensive understanding of the spinopelvic factors that influence dislocation, will likely reduce the risk of dislocation and revision over time.
»: The contemporary liner and shell options for primary THA, in order of increasing constraint and stability, include (1) neutral, (2) lateralized, (3) face-changing (oblique), (4) lipped (high-wall) with or without lateralization, (5) modular and anatomic dual-mobility, and (6) constrained options.
»: Different liner designs can alter functional anteversion, inclination, and jump distance, and can be used to minimize a single predictable dislocation vector (lipped [high-wall] liners) or multiple vectors of instability risk when the dislocation direction is unpredictable (dual-mobility liners).
»: Liner selection should be based on the patient-specific risk of dislocation, including static anatomic (e.g., large anterior inferior iliac spine or greater trochanter morphology), dynamic anatomic (e.g., limited sitting-standing change in the sacral slope), and demographic or medical (e.g., neurocognitive disorders and obesity) risk factors.
