Highly Cross-linked Polyethylene Liner Dissociation from a Cement-less Modular Acetabular Shell: Two Case Reports

Shunsuke Kawano*, Motoki Sonohata, Masaru Kitajima, Masaaki Mawatari
Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan

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© Kawano et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga 849-8501, Japan; Tel: +81-952-34-2343; Fax: +81-952-34-2059; E-mail:


Liner dissociation of polyethylene from a cementless acetabular socket following total hip arthroplasty (THA) is a rare complication. Cross-linked polyethylene liner dissociation from AMS-HA shell (KYOCERA Med, Osaka, Japan) occurred in 2 out of the 4153 (0.04%) cases approximately 10 years after undergoing surgery at our institute. First case was an 80-year-old female who underwent right THA along with subtrochanteric femoral shortening osteotomy due to complete dislocation hip, and second case was a 72-year-old male, who underwent right THA due to coxarthrosis. A 26 mm femoral head and CPE liner were used in both cases and the inclination degree of the acetabular socket was within 50°.There was no implant loosening in both cases. There was partial damage in the elevated rim on the alternative side and scratches on the back side in the both extracted CPE liner. It was surmised that liner dissociation was caused due to a problem in the liner fixing format of the push in type of the present model.

Keywords: Total hip arthroprasty, Highly cross-linked polyethylene, Liner dissociation, Cementless modular acetabular shell, Complication, Locking mechanism revision.