Isolated Head and Liner Exchange for Polyethylene Wear and Periprosthetic Osteolysis in Revision Hip Arthroplasty: A Review

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. Theaimofthestudy— 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.