Modular revision for polyethylene insert wear 28 years later after primary total hip arthroplasty: a clinical case

Introduction. Osteolysis caused by polyethylene wear debris remains a leading cause of revision total hip arthroplasty, particularly in young and active patients.

Purpose of the study - to present a clinical case of a successful long-term (28 years) total hip arthroplasty performed on a 27-year-old patient. The key factors for the success of the primary endoprosthesis were the correct positioning of the components and the use of a ceramic-cross-linked polyethylene friction couple. In addition, an algorithm for revision interventions for inlay wear and periprosthetic osteolysis is presented.

Materials and Methods. A 55-year-old male patient came to the clinic with complaints of pain in the area of the right hip joint, which increased with loading. From the anamnesis it is known that in 1996, at the age of 27, the patient underwent primary total hip replacement of the right hip joint for aseptic necrosis of the femoral head. At the follow-up examination, the patient was found to have pain syndrome. The Harris scale score was 45 points. Radiographs and CT scans showed signs of head decentration in the acetabulum and extensive zones of periacetabular osteolysis.

Results. One year after surgery, the patient walks without a limp, assessing the result of the revision treatment as excellent. The amplitude of passive movements: extension/flexion 5°/0°/120°, abduction/adduction 30°/0°/30°, external/internal rotation 30°/0°/30°. The functional assessment of the joint according to the Harris scale was 90 points. On control radiographs, the position of the endoprosthesis components was correct, the periacetabular osteolytic defect was filled with allogenic bone.

Conclusions. This case highlights the importance of accurate component positioning and optimal bearing couple selection for achieving long-term success in total hip arthroplasty. Isolated replacement of modular components with bone grafting of an osteolytic defect may be a justifiable choice of surgical management for inlay wear and osteolysis, provided the components are stable in fixation

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