Hip Pelvis HP Hip & Pelvis 2287-3260 2287-3279 Korean Hip Society 10.5371/hp.2013.25.4.286 Case Report Exchange and Reorientation of an Elevated-rim Polyethylene Liner for the Recurrent Anterior Subluxation after Total Hip Arthroplasty - A Case Report - Moon Nam Hoon MD Shin Won Chul MD Suh Kuen Tak MD Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. Address reprint request to Kuen Tak Suh, MD. Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea. TEL: +82-55-360-2125, FAX: +82-55-360-2155, kuentak@pusan.ac.kr 12 2013 31 12 2013 25 4 286 291 01 10 2013 13 12 2013 13 12 2013 Copyright © 2013 by Korean Hip Society 2013 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Total hip arthroplasty for osteoarthritis of the right hip was performed in a 62-year-old female patient with right-side weakness due to cerebral infarction. Because the second cerebral infarction aggravated right-side weakness, recurrent anterior subluxation occurred two years after surgery. We report on a case of recurrent anterior subluxation of total hip arthroplasty, which was treated successfully by exchange and reorientation of an elevated-rim polyethylene, and discuss studies reporting on recurrent subluxation after total hip arthroplasty and its treatment.

 Total hip arthroplasty Recurrent subluxation Polyethylene reorientation Liaw CK Yang RS Hou SM Wu TY Fuh CS Measurement of the acetabular cup anteversion on simulated radiographs J Arthroplasty 2009 24 468 474 Charnley J Low friction arthroplasty of the hip: theory and practice 1st ed New York Springer 1979 Cobb TK Morrey BF Ilstrup DM The elevated-rim acetabular liner in total hip arthroplasty: relationship to postoperative dislocation J Bone Joint Surg Am 1996 78 80 86 Bosco JA Benjamin JB Loosening of a femoral stem associated with the use of an extended-lip acetabular cup liner. A case report J Arthroplasty 1993 8 91 93 Murray DW Impingement and loosening of the long posterior wall acetabular implant J Bone Joint Surg Br 1992 74 377 379 Graham GP Jenkins AI Mintowt-Czyz W Recurrent dislocation following hip replacement: brief report J Bone Joint Surg Br 1988 70 675 Lewinnek GE Lewis JL Tarr R Compere CL Zimmerman JR Dislocations after total hip-replacement arthroplasties J Bone Joint Surg Am 1978 60 217 220 Saadat E Diekmann G Takemoto S Ries MD Is an algorithmic approach to the treatment of recurrent dislocation after THA effective? Clin Orthop Relat Res 2012 470 482 489 Lachiewicz PF Soileau E Ellis J Modular revision for recurrent dislocation of primary or revision total hip arthroplasty J Arthroplasty 2004 19 424 429

Radiographs illustrate the case of a 62-year-old woman who underwent the cementless total hip arthroplasty. (A) Anteroposterior radiograph demonstrates the inclination and the anteversion of cup. The inclination is defined as the angle between the inter-tear drop line and the long axis of the ellipse which is formed by the window opening of the cup. The anteversion is measured according to Liaw's method1). The shaft axis of the ellipse "S" and the total length "TL" of the projected cross-section of the cup along the short axis is measured. (B) Translateral radiograph shows the position of the component.

After 12 days of primary total hip arthroplasty, (A) anteroposterior and (B) translateral radiographs show the anterior dislocation.

Retrieved polyethylene demonstrates wears in the 9 o'clock direction (black arrow) due to the impingement between the neck of femoral component and elevated rim and in the 3 o'clock direction (white arrow) due to recurrent anterior subluxation of femoral head.

Postoperative (A) anteroposterior and (B) translateral radiographs of the right hip show that the component is acceptable position.

5 years follow-up (A) anteroposterior and (B) translateral radiographs of the right hip show that the component is stable with no evidence of loosening and subluxation.