Abstract Background Addressing recurrent instability in patients with poor bone stock and inadequate abductor tensioning remains a challenge in revision total hip arthroplasty (THA). One treatment method is implantation of a constrained liner. The purpose of this study was to determine clinical outcomes, re-dislocation rate, and revisions of a focally constrained liner in a high risk patient cohort. Methods 58 hips between 2008 and 2011 underwent implantation of a focally constrained liner. 19 were placed concurrent with acetabular component revision and 39 were placed into a well-fixed acetabular shell. Mean age was 69 years and mean number of previous ipsilateral hip surgeries was 4.2. At mean follow-up of 3.5 years, we analyzed clinical outcomes, re-dislocation, and revisions. Results Mean HHS was 74. 14 hips (24%) were revised and 3 hips (5%) required reoperation at final follow-up. 11 hips (19%) re-dislocated at a mean time to dislocation of 12.2 months. 31% (11 of 36 patients) that underwent modular exchange specifically for instability re-dislocated. Risk factors for re-dislocation included number of previous surgeries (p=0.013), implantation of a 28-mm femoral head (HR 12.8), revision indication of instability (p=0.04), and modular exchange with constrained liner implantation without acetabular shell revision (p=0.01). Discussion Implantation of a focally constrained liner in revision THA for recurrent instability has a high failure rate, especially with a modular exchange. While concurrent acetabular revision had a lower re-dislocation rate, the decision to revise a well fixed cup should be weighed with potential complications associated with cup revision.