Exactech Connexion GXL Hip Liners

Exactech Connexion GXL Hip Liners are polyethylene pieces that fit within hip implants used for primary and revision hip replacement surgery. Exactech has announced that these liners have been transitioned entirely out of the U.S. market in favor of the company’s XLE liner.

Last Modified: March 21, 2024
Fact Checked

Editors carefully fact-check all Drugwatch.com content for accuracy and quality.

Drugwatch.com has a stringent fact-checking process. It starts with our strict sourcing guidelines.

We only gather information from credible sources. This includes peer-reviewed medical journals, reputable media outlets, government reports, court records and interviews with qualified experts.

Why Trust DrugWatch?

Drugwatch.com has been empowering patients for more than a decade

Drugwatch.com has provided reliable, trusted information about medications, medical devices and general health since 2008. We’ve also connected thousands of people injured by drugs and medical devices with top-ranked national law firms to take action against negligent corporations.

Our team includes experienced medical writers, award-winning journalists, researchers and certified medical and legal experts. Drugwatch.com is HONCode (Health On the Net Foundation) certified. This means the high-quality information we provide comes from credible sources, such as peer-reviewed medical journals and expert interviews.

The information on Drugwatch.com has been medically and legally reviewed by more than 30 expert contributors, including doctors, pharmacists, lawyers, patient advocates and other health care professionals. Our writers are members of professional associations, including American Medical Writers Association, American Bar Association, The Alliance of Professional Health Advocates and International Society for Medical Publication Professionals.

About Drugwatch.com

  • Assisting patients and their families since 2008.
  • Helped more than 12,000 people find legal help.
  • A+ rating from the Better Business Bureau.
  • 5-star reviewed medical and legal information site.
Learn More About Us


"Drugwatch opened my eyes to the realities of big pharmacy. Having a family member with major depression and anxiety, I was looking for information on her medications. I found information that was very helpful, that her psychiatrist never told her."
Marianne Zahren Patient’s Family Member
  • Google Business Rating
  • BBB A+ Rating Logo

What Is an Exactech Connexion GXL Hip Liner?

Exactech Connexion GXL liners were used as part of its Novation and Alteon hip replacement systems. Featuring irradiated ultra-high-molecular-weight polyethylene (UHMWPE) plastic, these liners were intended to resist wear. Risks of premature wear were observed, however, and after studying the issue, the company notified surgeons in June 2021 that “the GXL liner has been transitioned entirely out of the US market.

GXL hip liners had been indicated for use in people who needed a total hip replacement because of osteoarthritis, osteonecrosis, rheumatoid arthritis, congenital hip dysplasia, ankylosing spondylitis and other degenerative hip problems. A 2022 study reported that, following a hip replacement, 46.7% of participants experienced a clinically significant improvement, while 15.5% experienced worsened outcomes. 

The move away from the GXL liners has meant a transition to XLE liners, also UHMWPE plastic, which Exactech describes as its “next generation polyethylene highly crosslinked Vitamin E liners.” The XLE liners received FDA approval in March 2018, and, according to Exactech, outperforms the GXL liners.

What Should I Do If I Have a GXL Liner?

Initially, Exactech did not describe the transition away from GXL liners as a recall. The company officially said, “No, Exactech is not recalling the GXL liner.” However, they advised hip replacement patients to speak with their surgeon. Your surgeon’s office can confirm the model and make of your hip replacement and if an Exactech GXL liner was implanted.

For those who confirm that their implant is an Exactech hip replacement system with a GXL liner and “are less than six (6) years from index surgery and who have not been seen in over 12 months” are advised to return to their surgeon’s office for an exam and x-rays to determine if there’s wear or deterioration. 

Replacement or revision surgery is not generally recommended, but for those with significant wear, this may be necessary. 

In March 2023, FDA confirmed that Exactech issued a recall for some GXL Liners for Novation, Acumatch and MCS hip replacements in June 2021. However, Exactech didn’t know why the devices suffered from excessive and premature wear. The FDA classified this as Class II recall in July 2022. Exactech then expanded hip replacement recall to include all devices packaged in defective bags in August 2022, and the FDA classified this as a Class II recall in September 2022.

How They Work

Exactech Connexion GXL hip liners, also called acetabular liners, are one part of a complete hip implant.

In order to recreate the hip joint, implants have a ball that fits into a cup called an acetabular component. The component is made of an acetabular shell and a liner. This ball and cup fit into the hip socket. A stem attaches to the ball and connects to the thighbone.

Acetabular liners fit in between the ball and the acetabular shell. This allows the implant to move. The liners can be made of ceramic or plastic.

Exactech Connexion GXL hip liners are contraindicated in patients with severe infection, patients with neuromuscular disorders that affect the hip joint, and patients whose weight, activity level, or age would cause early failure.

Complications from Wear

Complications from hip replacement surgery are typically rare, but conditions like osteolysis can occur when debris from polyethylene wear builds up in the joint. It causes the surrounding tissue and bone to degenerate. This can cause implant loosening and lead to premature revision surgery.

Injuries associated with implant loosening include:
  • Pain
  • Stiffness
  • Limited mobility
  • Loosening from osteolysis
  • Radiographic evidence of osteolysis
  • Revision because of polyethylene wear or osteolysis

Between 2019 and 2021, Exactech observed early linear and volumetric wear in Connexion GXL liners implanted in .118% of patients between 3-6 years of their hip replacement surgery. The company notes that in “some of these patients, wear has led to proximal femoral and acetabular osteolysis.”

Patients experiencing any side effects from hip replacement surgery should contact their surgeon. 

For those who have experienced complications from Exactech Connexion GXL hip liners, the company has established means of compensation. Impacted patients have also consulted attorneys and explored their legal options, including filing lawsuits against Exactech, to obtain compensation for medical expenses, as well as pain and suffering.

See if You Qualify for a Lawsuit Our Partners

Our Trusted Legal Partners

Drugwatch partners with trusted law firms to help you take legal action. After submitting the form, one of Drugwatch's partners will contact you for a free case review.

simmons hanly conroy law firm logo weitz and luxenberg logo sokolove law firm logo levin papantonio rafferty law firm logo nigh goldenberg raso and vaughn law firm logo morgan & morgan logo the ferraro law firm logo meirowitz & wasserberg law firm logo

History of Exactech GXL Studies

Exactech’s hip simulator studies showed a 59% reduction in the wear rate.

However, two 2020 studies published in peer-reviewed medical journals found that the Exactech Connexion GXL liner may be prone to a high rate of early failure. Study authors concluded the failure rate was caused by high wear rates that led to osteolysis.

High Rate of Early Failure

Dr. W. Christian Thomas and colleagues at the University of Florida College of Medicine published their study findings in the Journal of Arthroplasty.

Authors looked at their institutional database for patients who had significant osteolysis after a primary hip replacement with an Exactech Connexion GXL liner from January 2009 to June 2019.

They identified 12 patients, and nine of them were undergoing revision surgery because of complications. They found the average time before the implants failed was 55.9 months, or about five years.

Authors did not find any patient risk factors or implant positioning, so they concluded it could be the implant’s design causing early failure.

“The Exactech Connexion GXL liner may be prone to a high rate of early failure from wear and severe secondary osteolysis. We recommend close surveillance of patients with this bearing surface,” authors concluded.

‘Catastrophic Early Polyethylene Wear’

Dr. Cynthia Kahlenberg and colleagues at the Hospital for Special Surgery published their review in Arthroplasty Today.

Authors looked at 204 total hip replacements performed by one surgeon using the Exactech Connexion GXL liner. They found five cases of osteolysis and severe wear that occurred within five years of surgery.

All five patients reported hip pain. X-rays found wear with osteolysis in the joints, and MRIs found inflammation.

“This review of 5 cases of catastrophic early polyethylene wear demonstrates a concerning trend with the use of the Exactech Connexion GXL liner,” authors concluded.

They recommended further investigation.

Please seek the advice of a medical professional before making health care decisions.