Optimizing Hip Revision Surgery: The Role of Constrained Acetabular Liners

Constrained acetabular liners are seeing renewed use in revision hip arthroplasty to mechanically address recurrent instability and complex soft‑tissue deficiency. Contemporary mid‑term outcomes with modern designs constrained acetabular liners support the use of these devices for recurrent instability in carefully chosen revision cases.

These data shift prior practice by reinforcing that constrained liners are specialist options reserved for recurrent dislocation or clear mechanical instability rather than standard implants for all revisions. Escalation to constrained fixation is reasonable after documented failure of less‑constraining measures or when mechanical conditions make dislocation likely.

In revision cohorts, reported outcomes include an 88.9% implant survival rate at a mean follow‑up near 32 months, with roughly 65% of patients achieving good‑to‑excellent scores on validated patient-reported outcome measures. Taken together, these survival and functional data indicate a meaningful stabilization benefit for appropriately selected patients.

Compared with dual‑mobility constructs and large‑diameter heads, constrained liners provide definitive mechanical containment when other methods fail but incur higher complication risk and a reduced range of motion. For that reason, they serve as a salvage or selective tool rather than a first‑line anti‑dislocation strategy.

Typical indications include recurrent dislocation despite conventional measures, severe abductor deficiency, loosening that compromises stability, and high‑risk mechanical anatomy. Reported complications—impingement, liner disengagement, and mechanical failure—require targeted surveillance. Preoperative planning should address component orientation, realistic ROM expectations, and explicit informed consent about these trade‑offs.

Key Takeaways:

• Modern constrained liners demonstrate mid‑term implant survivorship near 88.9% and about 65% good‑to‑excellent functional results in revision settings.
• Patients with recurrent dislocation, significant soft‑tissue deficiency, or mechanical risk factors are the primary candidates for constrained liners.