Massive Eccentric Wear of the Acetabular Cup after Polyethylene Liner Abrasion in Hip Arthroplasty may lead to a high Risk of Injury during Revision Surgery

INTRODUCTION: Polyethylene wear is known to be a major cause of long-term failure after primary hip arthroplasty which results in the activation of an innate immune response with subsequent osteolysis and component loosening. However, polyethylene wear in hip arthroplasty may be asymptomatic for a long time and following massive, eccentric abrasion of the cup with subluxation of the femoral head after fully polyethylene wear has not yet been described. Hereby, we present a case of rapid progressive eccentric wear of the acetabular cup after complete polyethylene liner abrasion in a ceramic-on-polyethylene bearing. CASE REPORT: A 80-year-old-lady presented on our emergency department with a subluxated hip arthroplasty on the right side implanted 30 years ago. The X-ray showed a Zweymüller stem combined with a Gartenmann cup and a ceramic head with excessive eccentric wear of the acetabular cup with razor blade sharp edges after fully polyethylene liner abrasion. CONCLUSION: Progressive eccentric wear of the acetabular cup after fully polyethylene liner abrasion in ceramic-on-polyethylene bearings in hip arthroplasty may be asymptomatic for a long time but may progress rapidly. To prevent patients from extensive revision surgery and the revision surgeon from serious injury due to intraoperatively findings such as razor blade sharp edges, routine long-term follow-up radiographic evaluation is crucial.