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Peer-reviewedCC BYArchives of orthopaedic and trauma surgery

Patient-specific management in high-risk revision total hip arthroplasty: mid-term outcomes of a next-generation constrained acetabular liner.

  • Farouk Khury1,2,3
  • Blaine Luebbering4
  • Garrett Ruff4
  • Laith Bahlouli4
  • Anzar Sarfraz4
  • Ran Schwarzkopf4
  • Vinay K Aggarwal5
5 affiliations
  1. 1The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. [email protected].
  2. 2Department of Orthopedic Surgery, New York University Langone Medical Center, New York, USA. [email protected].
  3. 3Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel. [email protected].
  4. 4Department of Orthopedic Surgery, New York University Langone Medical Center, New York, USA.
  5. 5Department of Orthopedic Surgery, New York University Langone Medical Center, New York, USA. [email protected].
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Abstract

Background

Managing recurrent instability in revision total hip arthroplasty (rTHA) requires a personalized approach, as traditional constrained liners often yield suboptimal results due to locking-mechanism failure and limited impingement-free range of motion. This study aimed to evaluate the mid-term clinical outcomes of a novel constrained acetabular liner (CAL) when utilized as a patient-specific solution for a high-risk cohort undergoing complex rTHA. By tailoring the constraint to individual biomechanical deficits, this next-generation device seeks to mitigate historic failure modes.Methods

We retrospectively reviewed 32 patients who underwent 37 rTHA procedures with a next-generation CAL at a single urban academic center between March 2017 and October 2023. Average follow-up was 4.7 years (range, 0.3 to 9.7 years). The most common indication for rTHA was instability (70.3%), followed by infection (16.2%), aseptic loosening (10.8%), and polyethylene wear (2.7%). Just over one third of patients (37.5%) had undergone a prior revision. Preoperative constructs included fixed-bearing (37.8%), dual-mobility (32.4%), CAL (24.3%), static spacer (2.7%), and hemiarthroplasty (2.7%).Results

In most procedures (70.3%), the CAL was implanted into a pre-existing acetabular cup, whereas 29.7% involved both cup and liner revision. Following rTHA, no cases of implant wear, breakage, acetabular cup aseptic loosening, or periprosthetic fracture were observed. Six patients (18.8%) underwent a total of sixteen subsequent reoperations after CAL implantation-10 for instability and 6 for infection. Among instability-related reoperations, 4 involved revision to a new next-generation CAL. Survivorship free from all-cause reoperation was 83.8% at one year and 72.6% at latest follow-up.Conclusions

This study demonstrates favorable mid-term clinical outcomes and reoperation-free survivorship following complex revision THA using a novel constrained acetabular liner system. For patient cohorts suffering from severe recurrent dislocation, this next-generation CAL provides an effective, tailored tool in the surgical armamentarium by adapting to unique patient anatomy and soft-tissue compromises. Further research with larger sample sizes and extended follow-up is needed to assess long-term durability.

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Cite

BibTeXRIS
BibTeX
@article{khury2026patientspecific,
  title = {{Patient-specific management in high-risk revision total hip arthroplasty: mid-term outcomes of a next-generation constrained acetabular liner.}},
  author = {Farouk Khury and Blaine Luebbering and Garrett Ruff and Laith Bahlouli and Anzar Sarfraz and Ran Schwarzkopf and Vinay K Aggarwal},
  journal = {Archives of orthopaedic and trauma surgery},
  year = {2026},
  month = oct,
  doi = {10.1007/s00402-026-06527-6},
  url = {https://europepmc.org/article/MED/42902017},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Patient-specific management in high-risk revision total hip arthroplasty: mid-term outcomes of a next-generation constrained acetabular liner.
AU  - Farouk Khury
AU  - Blaine Luebbering
AU  - Garrett Ruff
AU  - Laith Bahlouli
AU  - Anzar Sarfraz
AU  - Ran Schwarzkopf
AU  - Vinay K Aggarwal
PY  - 2026
DA  - 2026/10/20
JO  - Archives of orthopaedic and trauma surgery
DO  - 10.1007/s00402-026-06527-6
UR  - https://europepmc.org/article/MED/42902017
AB  - Background  Managing recurrent instability in revision total hip arthroplasty (rTHA) requires a personalized approach, as traditional constrained liners often yield suboptimal results due to locking-mechanism failure and limited impingement-free range of motion. This study aimed to evaluate the mid-term clinical outcomes of a novel constrained acetabular liner (CAL) when utilized as a patient-specific solution for a high-risk cohort undergoing complex rTHA. By tailoring the constraint to individual biomechanical deficits, this next-generation device seeks to mitigate historic failure modes.Methods  We retrospectively reviewed 32 patients who underwent 37 rTHA procedures with a next-generation CAL at a single urban academic center between March 2017 and October 2023. Average follow-up was 4.7 years (range, 0.3 to 9.7 years). The most common indication for rTHA was instability (70.3%), followed by infection (16.2%), aseptic loosening (10.8%), and polyethylene wear (2.7%). Just over one third of patients (37.5%) had undergone a prior revision. Preoperative constructs included fixed-bearing (37.8%), dual-mobility (32.4%), CAL (24.3%), static spacer (2.7%), and hemiarthroplasty (2.7%).Results  In most procedures (70.3%), the CAL was implanted into a pre-existing acetabular cup, whereas 29.7% involved both cup and liner revision. Following rTHA, no cases of implant wear, breakage, acetabular cup aseptic loosening, or periprosthetic fracture were observed. Six patients (18.8%) underwent a total of sixteen subsequent reoperations after CAL implantation-10 for instability and 6 for infection. Among instability-related reoperations, 4 involved revision to a new next-generation CAL. Survivorship free from all-cause reoperation was 83.8% at one year and 72.6% at latest follow-up.Conclusions  This study demonstrates favorable mid-term clinical outcomes and reoperation-free survivorship following complex revision THA using a novel constrained acetabular liner system. For patient cohorts suffering from severe recurrent dislocation, this next-generation CAL provides an effective, tailored tool in the surgical armamentarium by adapting to unique patient anatomy and soft-tissue compromises. Further research with larger sample sizes and extended follow-up is needed to assess long-term durability.
SN  - 0936-8051
SN  - 1434-3916
ER  -