Acetabular Component and Liner Selection for the Prevention of Dislocation After Primary Total Hip Arthroplasty.

Overview

»: Primary total hip arthroplasty (THA) is a reproducible and efficacious procedure for patients with end-stage osteoarthritis; however, dislocation remains the most common cause of revision arthroplasty. »: Technological advancements in acetabular component design and liner options, in conjunction with a more comprehensive understanding of the spinopelvic factors that influence dislocation, will likely reduce the risk of dislocation and revision over time. »: The contemporary liner and shell options for primary THA, in order of increasing constraint and stability, include (1) neutral, (2) lateralized, (3) face-changing (oblique), (4) lipped (high-wall) with or without lateralization, (5) modular and anatomic dual-mobility, and (6) constrained options. »: Different liner designs can alter functional anteversion, inclination, and jump distance, and can be used to minimize a single predictable dislocation vector (lipped [high-wall] liners) or multiple vectors of instability risk when the dislocation direction is unpredictable (dual-mobility liners). »: Liner selection should be based on the patient-specific risk of dislocation, including static anatomic (e.g., large anterior inferior iliac spine or greater trochanter morphology), dynamic anatomic (e.g., limited sitting-standing change in the sacral slope), and demographic or medical (e.g., neurocognitive disorders and obesity) risk factors.