Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics1774710.17816/2311-2905-17747ReviewsОбзорыReviewsReview ArticleIsolated Head and Liner Exchange for Polyethylene Wear and Periprosthetic Osteolysis in Revision Hip Arthroplasty: A ReviewМодульная ревизия эндопротезов тазобедренного сустава у пациентов с износом полиэтиленовых вкладышей и перипротезным остеолизом: обзор литературыhttps://orcid.org/0009-0001-4332-2574StafeevDmitry V.СтафеевДмитрий Викторович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

stafeevd@gmail.comhttps://orcid.org/0000-0002-7597-2918SpetsialnyiDenis V.СпециальныйДенис Владимирович
Russian Federation
specialnyyy@gmail.comhttps://orcid.org/0009-0002-0569-3945LyakhAleksey R.ЛяхАлексей Романович
Russian Federation
Arliahk@rniito.ruhttps://orcid.org/0009-0007-0910-3451IevNikita V.ИевНикита Владимирович
Russian Federation
ievnikos@mail.ruhttps://orcid.org/0000-0003-0828-7678DenisovAlexey O.ДенисовАлексей Олегович

Dr. Sci. (Med.)

д-р мед. наук

med-03@ya.ruhttps://orcid.org/0000-0003-0733-2414TikhilovRashid M.ТихиловРашид Муртузалиевич

Dr. Sci. (Med.), Professor,Corresponding Member of the RAS

д-р мед. наук, профессор, чл.-кор. РАН

rtikhilov@gmail.comVreden National Medical Research Center of Traumatology and OrthopedicsФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Минздрава России150920253131391532307202515082025Copyright ©; 2025, Eco-VectorCopyright ©; 2025, Эко-ВекторCopyright ©; 2025,2025Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journal.rniito.org/jour/article/view/17747

Background. The growing number of primary total hip arthroplasties (THAs) and the associated long-term complications — such as polyethylene wear and periprosthetic osteolysis — underscore the importance of this technique. Although isolated head-liner exchange offers clinical advantages, including reduced surgical morbidity, shorter operative time, and expedited postoperative recovery, there remains a lack of clearly defined indications and patient selection criteria for its optimal application.

The aim of the study — to synthesize current perspectives on isolated head and liner exchange in patients presenting with polyethylene wear and osteolysis surrounding stable hip prosthesis components, based on a comprehensive review of the international literature.

Methods. A systematic literature search was conducted in PubMed/MEDLINE (English), eLIBRARY (Russian), and Google Scholar (English and Russian) databases. Search terms included: osteolysis acetabular, revision total hip arthroplasty, polyethylene liner wear, isolated head and liner exchange. Titles and abstracts were screened for relevance, followed by full-text evaluation. Articles without accessible full-text versions were excluded from the analysis.

Results. The most frequent complications following isolated head-liner exchange are prosthetic dislocation and aseptic loosening. Identified risk factors include suboptimal component positioning, small femoral head diameter, extensive osteolytic lesions, and questionable stability of the acetabular component. Bone grafting of osteolytic defects may help mitigate these risks, though its efficacy remains under investigation. Advances in preoperative imaging, including CT and 3D reconstruction, have significantly improved surgical planning accuracy. Current evidence suggests comparable implant survivorship between cemented and press-fit liner fixation techniques.

Conclusion. Isolated head and liner exchange, provided that the implants are well-fixed and positioned correctly, represents a viable and less invasive alternative to complete component revision. However, further high-quality studies are warranted to refine patient selection criteria and to establish standardized indications for this approach.

Актуальность. Модульная ревизия эндопротезов тазобедренного сустава представляет собой изолированную замену вкладыша и головки при сохранении стабильных компонентов. Актуальность данной операции обусловлена ростом числа первичных эндопротезирований и связанных с этим осложнений: износа полиэтилена и перипротезного остеолиза. Несмотря на клинические преимущества модульной ревизии — малая травматичность, сокращение времени операции и быстрая реабилитация — остаются вопросы относительно четких критериев отбора пациентов для данного вмешательства.

Цель обзора — на основании анализа данных отечественной и зарубежной литературы обобщить современные взгляды на выполнение модульной ревизии у пациентов с износом и остеолизом вокруг стабильных компонентов эндопротеза тазобедренного сустава.

Материал и методы. Поиск публикаций осуществлялся в базах данных PubMed/MEDLINE (на английском языке), eLIBRARY (на русском языке) и Google Scholar (на русском и английском языках). Были использованы ключевые слова: эндопротезирование тазобедренного сустава, ревизионное эндопротезирование тазобедренного сустава, модульная ревизия эндопротеза тазобедренного сустава, изолированная замена вкладыша и головки эндопротеза тазобедренного сустава, износ полиэтилена, перипротезный остеолиз, osteolysis acetabular, revision total hip arthroplasty, polyethylene liner wear, isolated head and liner exchange. Проверка на соответствие тематике исследования выполнялась по заголовкам и резюме статей, после чего проводился анализ полнотекстовых версий.

Результаты. Основные осложнения после модульной ревизии — вывихи и асептическое расшатывание компонентов. Ряд факторов риска включает неправильное позиционирование компонентов, малый диаметр головки, обширный остеолиз и сомнительную стабильность вертлужного компонента. Костная пластика остеолитических дефектов может снизить риск осложнений, однако ее роль до конца не определена. Современные методы КТ и 3D-реконструкции существенно повышают точность предоперационного планирования. Результаты исследований демонстрируют сопоставимую выживаемость имплантатов при применении цементной и оригинальной фиксации вкладыша.

Заключение. Модульная ревизия при условии хорошей фиксации и правильного расположения имплантатов является эффективной альтернативой полной ревизии с полной заменой компонентов эндопротеза. Однако необходимы дальнейшие исследования, направленные на уточнение показаний, критериев отбора пациентов для данного оперативного лечения.

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