{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:44:41Z","timestamp":1792518281571,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Managing recurrent instability in revision total hip arthroplasty (rTHA) requires a personalized approach, as traditional constrained liners often yield suboptimal results due to locking-mechanism failure and limited impingement-free range of motion. This study aimed to evaluate the mid-term clinical outcomes of a novel constrained acetabular liner (CAL) when utilized as a patient-specific solution for a high-risk cohort undergoing complex rTHA. By tailoring the constraint to individual biomechanical deficits, this next-generation device seeks to mitigate historic failure modes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 32 patients who underwent 37 rTHA procedures with a next-generation CAL at a single urban academic center between March 2017 and October 2023. Average follow-up was 4.7 years (range, 0.3 to 9.7 years). The most common indication for rTHA was instability (70.3%), followed by infection (16.2%), aseptic loosening (10.8%), and polyethylene wear (2.7%). Just over one third of patients (37.5%) had undergone a prior revision. Preoperative constructs included fixed-bearing (37.8%), dual-mobility (32.4%), CAL (24.3%), static spacer (2.7%), and hemiarthroplasty (2.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In most procedures (70.3%), the CAL was implanted into a pre-existing acetabular cup, whereas 29.7% involved both cup and liner revision. Following rTHA, no cases of implant wear, breakage, acetabular cup aseptic loosening, or periprosthetic fracture were observed. Six patients (18.8%) underwent a total of sixteen subsequent reoperations after CAL implantation\u201410 for instability and 6 for infection. Among instability-related reoperations, 4 involved revision to a new next-generation CAL. Survivorship free from all-cause reoperation was 83.8% at one year and 72.6% at latest follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrates favorable mid-term clinical outcomes and reoperation-free survivorship following complex revision THA using a novel constrained acetabular liner system. For patient cohorts suffering from severe recurrent dislocation, this next-generation CAL provides an effective, tailored tool in the surgical armamentarium by adapting to unique patient anatomy and soft-tissue compromises. Further research with larger sample sizes and extended follow-up is needed to assess long-term durability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-026-06527-6","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:18:40Z","timestamp":1792516720000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient-specific management in high-risk revision total hip arthroplasty: mid-term outcomes of a next-generation constrained acetabular liner"],"prefix":"10.1007","volume":"146","author":[{"given":"Farouk","family":"Khury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blaine","family":"Luebbering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Ruff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laith","family":"Bahlouli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8297-3801","authenticated-orcid":false,"given":"Anzar","family":"Sarfraz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Schwarzkopf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay K.","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"issue":"9597","key":"6527_CR1","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1016\/S0140-6736(","volume":"370","author":"ID Learmonth","year":"2007","unstructured":"Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370(9597):1508\u20131519. https:\/\/doi.org\/10.1016\/S0140-6736(07)60457-7 PubMed PMID: 17964352","journal-title":"Lancet"},{"issue":"4","key":"6527_CR2","doi-asserted-by":"publisher","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","volume":"89","author":"S Kurtz","year":"2007","unstructured":"Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780\u2013785. 10.2106\/JBJS.F.00222 PubMed PMID: 17403800","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"6527_CR3","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.arth.2023.10.034","volume":"39","author":"KW Lawrence","year":"2024","unstructured":"Lawrence KW, Raymond HE, Sicat CS, Roof MA, Arshi A, Rozell JC et al (2024) Indications, Clinical Outcomes, and Re-Revisions Following Revision Total Hip Arthroplasty - Does Age Matter? J Arthroplasty 39(4):1036\u20131043. https:\/\/doi.org\/10.1016\/j.arth.2023.10.034 PubMed PMID: 37879423","journal-title":"J Arthroplasty"},{"issue":"1","key":"6527_CR4","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.jcot.2018.08.021","volume":"11","author":"S Yu","year":"2020","unstructured":"Yu S, Saleh H, Bolz N, Buza J, Iorio R, Rathod PA et al (2020) Re-revision total hip arthroplasty: Epidemiology and factors associated with outcomes. J Clin Orthop Trauma 11(1):43\u201346. https:\/\/doi.org\/10.1016\/j.jcot.2018.08.021 PubMed PMID: 32001983; PubMed Central PMCID: PMC6985171","journal-title":"J Clin Orthop Trauma"},{"issue":"12","key":"6527_CR5","doi-asserted-by":"publisher","first-page":"2996","DOI":"10.1016\/j.arth.2024.05","volume":"39","author":"GL Ruff","year":"2024","unstructured":"Ruff GL, Thomas J, Ashkenazi I, Grossman EL, Davidovitch RI, Schwarzkopf R (2024) How Has the Total Hip Arthroplasty Patient Population Changed? A Ten-Year Analysis of Total Hip Arthroplasty Patients From 2013 to 2022: A Retrospective, Single-Center Study. J Arthroplasty 39(12):2996\u20133003. https:\/\/doi.org\/10.1016\/j.arth.2024.05.081. PubMed PMID: 38830434","journal-title":"J Arthroplasty"},{"issue":"51\u201352","key":"6527_CR6","doi-asserted-by":"publisher","first-page":"884","DOI":"10.3238\/arztebl","volume":"111","author":"J Dargel","year":"2014","unstructured":"Dargel J, Oppermann J, Br\u00fcggemann GP, Eysel P (2014) Dislocation following total hip replacement. Dtsch Arzteblatt Int 111(51\u201352):884\u2013890. https:\/\/doi.org\/10.3238\/arztebl2014.0884 PubMed PMID: 25597367; PubMed Central PMCID: PMC4298240","journal-title":"Dtsch Arzteblatt Int"},{"issue":"9S2","key":"6527_CR7","doi-asserted-by":"publisher","first-page":"S306","DOI":"10.1016\/j.arth.2024.03","volume":"39","author":"NA Huebschmann","year":"2024","unstructured":"Huebschmann NA, Lawrence KW, Robin JX, Rozell JC, Hepinstall MS, Schwarzkopf R et al (2024) Does Surgical Approach Affect Dislocation Rate After Total Hip Arthroplasty in Patients Who Have Prior Lumbar Spinal Fusion? A Retrospective Analysis of 16,223 Cases. J Arthroplasty 39(9S2):S306\u2013S313. https:\/\/doi.org\/10.1016\/j.arth.2024.03.068 PubMed PMID: 38604275","journal-title":"J Arthroplasty"},{"issue":"7","key":"6527_CR8","doi-asserted-by":"publisher","first-page":"4491","DOI":"10.1007\/s00402-022-04678-w","volume":"143","author":"JHJ van Erp","year":"2023","unstructured":"van Erp JHJ, H\u00fcsken MFT, Filipe MD, Snijders TE, Kruyt MC, de Gast A et al (2023) Did the dislocation risk after primary total hip arthroplasty decrease over time? A meta-analysis across six decades. Arch Orthop Trauma Surg 143(7):4491\u20134500. https:\/\/doi.org\/10.1007\/s00402-022-04678-w PubMed PMID: 36357707; PubMed Central PMCID: PMC10293125","journal-title":"Arch Orthop Trauma Surg"},{"issue":"8","key":"6527_CR9","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1302\/0301-620X","volume":"97\u2013B","author":"MP Abdel","year":"2015","unstructured":"Abdel MP, Cross MB, Yasen AT, Haddad FS (2015) The functional and financial impact of isolated and recurrent dislocation after total hip arthroplasty. Bone Jt J 97\u2013B(8):1046\u20131049. https:\/\/doi.org\/10.1302\/0301-620X97B8.34952 PubMed PMID: 26224819","journal-title":"Bone Jt J"},{"key":"6527_CR10","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1080\/17453674.2021.1983973","volume":"93","author":"LL Hermansen","year":"2022","unstructured":"Hermansen LL, Viberg B, Overgaard S (2022) Patient-reported outcome after dislocation of primary total hip arthroplasties: a cross-sectional study derived from the Danish Hip Arthroplasty Register. Acta Orthop 93:29\u201336. https:\/\/doi.org\/10.1080\/17453674.2021.1983973 PubMed PMID: 34633915; PubMed Central PMCID: PMC8815764","journal-title":"Acta Orthop"},{"issue":"7","key":"6527_CR11","doi-asserted-by":"publisher","first-page":"2088","DOI":"10.1016\/j.arth.2017.02.046","volume":"32","author":"CU Gwam","year":"2017","unstructured":"Gwam CU, Mistry JB, Mohamed NS, Thomas M, Bigart KC, Mont MA et al (2017) Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to 2013. J Arthroplasty 32(7):2088\u20132092. https:\/\/doi.org\/10.1016\/j.arth.2017.02.046 PubMed PMID: 28336249","journal-title":"J Arthroplasty"},{"issue":"8","key":"6527_CR12","doi-asserted-by":"publisher","first-page":"3028","DOI":"10.1016\/j.arth.2021.04.028","volume":"36","author":"F Mancino","year":"2021","unstructured":"Mancino F, Jones CW, Sculco TP, Sculco PK, Maccauro G, De Martino I (2021) Survivorship and Clinical Outcomes of Constrained Acetabular Liners in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J Arthroplasty 36(8):3028\u20133041. https:\/\/doi.org\/10.1016\/j.arth.2021.04.028 PubMed PMID: 34030877","journal-title":"J Arthroplasty"},{"issue":"8","key":"6527_CR13","doi-asserted-by":"publisher","first-page":"122","DOI":"10.5312\/wjo.v3","volume":"3","author":"BC Werner","year":"2012","unstructured":"Werner BC, Brown TE (2012) Instability after total hip arthroplasty. World J Orthop 3(8):122\u2013130. https:\/\/doi.org\/10.5312\/wjo.v3i8.122 PubMed PMID: 22919568; PubMed Central PMCID: PMC3425631","journal-title":"World J Orthop"},{"issue":"5","key":"6527_CR14","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.1016\/j.arth.2018.01","volume":"33","author":"SA Jones","year":"2018","unstructured":"Jones SA (2018) Constrained Acetabular Liners. J Arthroplasty 33(5):1331\u20131336. https:\/\/doi.org\/10.1016\/j.arth.2018.01.026 PubMed PMID: 29525341","journal-title":"J Arthroplasty"},{"issue":"2","key":"6527_CR15","doi-asserted-by":"publisher","first-page":"115","DOI":"10.3928\/01477447-20090201-23","volume":"32","author":"C Yang","year":"2009","unstructured":"Yang C, Goodman SB (2009) Outcome and complications of constrained acetabular components. Orthopedics 32(2):115 PubMed PMID: 19301794","journal-title":"Orthopedics"},{"key":"6527_CR16","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/01.blo.0000218745.07366.60","volume":"447","author":"KR Berend","year":"2006","unstructured":"Berend KR, Lombardi AV, Welch M, Adams JB (2006) A constrained device with increased range of motion prevents early dislocation. Clin Orthop 447:70\u201375. https:\/\/doi.org\/10.1097\/01.blo.0000218745.07366.60 PubMed PMID: 16741476","journal-title":"Clin Orthop"},{"key":"6527_CR17","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.ijscr.2020.09.012","volume":"75","author":"Y Onochi","year":"2020","unstructured":"Onochi Y, Fukui K, Kaneuji A, Ichiseki T, Wang X, Kawahara N (2020) Dual mobility acetabular construct with freedom constrained liner for treatment of recurrent dislocations after total hip arthroplasty: A case report and literature review. Int J Surg Case Rep 75:94\u201399 .012 PubMed PMID: 32932039; PubMed Central PMCID: PMC7493044","journal-title":"Int J Surg Case Rep"},{"issue":"2","key":"6527_CR18","first-page":"165","volume":"106","author":"M Karvonen","year":"2017","unstructured":"Karvonen M, Karvonen H, Sepp\u00e4nen M, Liukas A, Koivisto M, M\u00e4kel\u00e4 KT (2017) Freedom Constrained Liner for the Treatment and Prevention of Dislocation in Total Hip Arthroplasty. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc 106(2):165\u2013172 doi:10.1177\/1457496916660035 PubMed PMID: 27456021","journal-title":"Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc"},{"issue":"11","key":"6527_CR19","doi-asserted-by":"publisher","first-page":"2239","DOI":"10.1007\/s00264-015-3082-2","volume":"40","author":"TJ M\u00e4kinen","year":"2016","unstructured":"M\u00e4kinen TJ, Fichman SG, Rahman WA, Amenabar T, Safir O, Gross AE et al (2016) The focally constrained liner is a reasonable option for revision of unstable total hip arthroplasty. Int Orthop 40(11):2239\u20132245. https:\/\/doi.org\/10.1007\/s00264-015-3082-2 PubMed PMID: 26695773","journal-title":"Int Orthop"},{"issue":"6","key":"6527_CR20","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1080\/17453674.2021.1939597","volume":"92","author":"O Pakarinen","year":"2021","unstructured":"Pakarinen O, Lainiala O, Reito A, Neuvonen P, M\u00e4kel\u00e4 K, Eskelinen A (2021) Implant survival of 662 dual-mobility cups and 727 constrained liners in primary THA: small femoral head size increases the cumulative incidence of revision. Acta Orthop 92(6):658\u2013664 PubMed PMID: 34238130; PubMed Central PMCID: PMC8641668","journal-title":"Acta Orthop"},{"issue":"7","key":"6527_CR21","doi-asserted-by":"publisher","first-page":"620","DOI":"10.2106\/JBJS.18.00607","volume":"101","author":"TS Brown","year":"2019","unstructured":"Brown TS, Tibbo ME, Arsoy D, Lewallen DG, Hanssen AD, Trousdale RT et al (2019) Long-Term Outcomes of Constrained Liners Cemented into Retained, Well-Fixed Acetabular Components. J Bone Joint Surg Am 101(7):620\u2013627. https:\/\/doi.org\/10.2106\/JBJS.18.00607 PubMed PMID: 30946196","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"6527_CR22","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/j.arth.2019","volume":"35","author":"DA Crawford","year":"2020","unstructured":"Crawford DA, Adams JB, Brown KW, Morris MJ, Berend KR, Lombardi AV (2020) Mid-Term Survivorship of a Novel Constrained Acetabular Device. J Arthroplasty 35(3):859\u2013863. https:\/\/doi.org\/10.1016\/j.arth.201909.049 PubMed PMID: 31668696","journal-title":"J Arthroplasty"},{"issue":"7","key":"6527_CR23","doi-asserted-by":"publisher","first-page":"1907","DOI":"10.1007\/s11999-011-2212-4","volume":"470","author":"PC Noble","year":"2012","unstructured":"Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV (2012) Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop 470(7):1907\u20131916. https:\/\/doi.org\/10.1007\/s11999-011-2212-4 PubMed PMID: 22179979; PubMed Central PMCID: PMC3369098","journal-title":"Clin Orthop"},{"issue":"5 Supple B","key":"6527_CR24","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1302\/0301-620X.106B5.BJJ-2023-0860.R1","volume":"106\u2013B","author":"KE Mallett","year":"2024","unstructured":"Mallett KE, Guarin Perez SF, Taunton MJ, Sierra RJ (2024) Incidence, treatment, and outcomes of modern dual-mobility intraprosthetic dissociations. Bone Jt J 106\u2013B(5 Supple B):98\u2013104. https:\/\/doi.org\/10.1302\/0301-620X.106B5.BJJ-2023-0860.R1","journal-title":"Bone Jt J"},{"issue":"5","key":"6527_CR25","doi-asserted-by":"publisher","first-page":"e60437","DOI":"10.7759\/cureus.60437","volume":"16","author":"CD Gerber","year":"2024","unstructured":"Gerber CD, Lee A, De Silva V, Yatsonsky D, Georgiadis GM (2024) Malseated Liner in Modular Dual Mobility Total Hip Replacement: A Report of Three Cases. Cureus 16(5):e60437. https:\/\/doi.org\/10.7759\/cureus.60437 PubMed PMID: 38883007; PubMed Central PMCID: PMC11179678","journal-title":"Cureus"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06527-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-026-06527-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06527-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:18:42Z","timestamp":1792516722000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-026-06527-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6527"],"URL":"https:\/\/doi.org\/10.1007\/s00402-026-06527-6","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"31 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the NYU Langone Health Institutional Review Board (IRB): i23-00714, 09\/24\/2024.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"375"}}