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Catastrophic acetabular wear following polyethylene liner dissociation with locking-tab damage after total hip arthroplasty: a case report

Year: 2026

Type: article

Abstract: Background: Polyethylene liner dissociation is an uncommon but potentially severe complication of total hip arthroplasty (THA). Loss of the intended bearing interface can permit direct femoral-head-acetabular-shell articulation, with progressive shell wear, metallic debris deposition, and acetabular bone loss. Case presentation: A 73-year-old woman developed left hip pain after an accidental sprain in February 2025, having reported no hip-related symptoms after primary THA in 2020. The index Mindray implants included a 48-mm acetabular shell, a highly cross-linked polyethylene liner, a 28-mm femoral head, and a size-10 stem. Radiographs and CT with three-dimensional volume-rendered reconstruction were used to assess acetabular bone loss, classified as Paprosky type IIA. Revision revealed polyethylene liner dissociation, catastrophic shell wear-through, extensive black metallic debris deposition, and a well-fixed femoral stem. Partial locking-tab damage was identified on gross inspection, but formal retrieval analysis was not performed. Acetabular revision with iliac-crest autografting was performed while retaining the femoral stem. At 6 months, the Harris Hip Score improved from 46 to 82, and radiographs showed a stable acetabular component with evidence of graft incorporation. Conclusion: This case illustrates the potential for clinically occult progression from liner dissociation to catastrophic head-on-shell wear. Gross locking-tab damage did not establish the initiating failure mechanism. Component-preserving acetabular revision was associated with a favorable short-term clinical and radiographic outcome in this patient.

Source: Frontiers in Surgery

DOI: 10.3389/fsurg.2026.1979979

Authors: Weida Li, Zhixing Liang, Zhuangzhuang Dong, Qian Sun, Yu Hou

Institution: Affiliated Hospital of Hebei University

Language: English

Topic: Orthopaedic implants and arthroplasty

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801