Rim Cracking of the Cross-Linked Longevity Polyethylene Acetabular Liner After Total Hip Arthroplasty

Tower, Stephen S.; Currier, John H.; Currier, Barbara H.; Lyford, Kimberly A.; Citters, Douglas W. Van; Mayor, Michael B.

doi:10.2106/jbjs.f.00758

Cited by 165 publications

(67 citation statements)

References 12 publications

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“…The reports of highly cross-linked fractured liners of Halley et al and Tower et al both indicated that larger liner diameters contributed to the etiology of the fractures [7-8], and our observations are consistent with their findings. However, in the case report of Furmanski et al, three of four fractured cases had a head diameter of 32 mm or above [8].…”

Section: Discussionsupporting

confidence: 92%

“…Halley et al presented a rim fractured highly cross-linked liner, which was attributed to a combination of malpositioning and a large femoral head diameter (40 mm) [6]. The case series investigated by Tower et al included four highly cross-linked liners from two bilateral revisions, all of the same design [7]. All of the implants in that series were vertically malpositioned in abduction, and the authors also cautioned against combining cross-linked UHMWPE with large diameter liners in malpositioned components.…”

Section: Introductionmentioning

confidence: 99%

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Crack Initiation in Retrieved Cross-Linked Highly Cross-Linked Ultrahigh-Molecular-Weight Polyethylene Acetabular Liners

Furmanski

Kraay

Rimnac

2011

The Journal of Arthroplasty

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Nine cross-linked UHMWPE acetabular liners were retrieved at revision surgery. Eight of the liners were fully intact and functional at retrieval. Six cases contained shallow initiated cracks at the root of rim notches; one crack had propagated several millimeters. Optical and electron microscopic inspection of the crack surfaces revealed clam shell markings, which are characteristic of fatigue crack initiation. Crack initiation at notches has been identified in reports of catastrophic cross-linked liner failures, with cracks initiation sites exhibiting similar morphology and clam shell markings. Thus, we believe the shallow cracks identified in this case series are precursors to catastrophic rim fracture. The results of this study recommend further investigations to clarify the etiology and prevalence of crack initiation in cross-linked acetabular liners.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Crack Initiation in Retrieved Cross-Linked Highly Cross-Linked Ultrahigh-Molecular-Weight Polyethylene Acetabular Liners

Furmanski

Kraay

Rimnac

2011

The Journal of Arthroplasty

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“…This, in turn, can lead to severe wear and gross fracture of the PE, particularly in liners with external fixation notches that further reduce the thickness of the PE and act as stress concentrations. These types of failure have long been reported for acetabular components featuring conventional PE [14, 20, 35, 43] and, more recently, highly crosslinked PEs [12, 19, 36, 45]. Investigation of these failure modes is beyond the scope of the present study, but they should be taken into account in determining the minimum liner thickness acceptable for clinical use in a particular design of acetabular components.…”

Section: Discussionmentioning

confidence: 80%

Wear versus Thickness and Other Features of 5-Mrad Crosslinked UHMWPE Acetabular Liners

Shen

Zhen

McKellop

2011

Clinical Orthopaedics &Amp; Related Research

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BackgroundThe low wear rates of crosslinked polyethylenes provide the potential to use larger diameters to resist dislocation. However, this requires the use of thinner liners in the acetabular component, with concern that higher contact stresses will increase wear, offsetting the benefits of the crosslinking.Questions/purposesWe asked the following questions: Is the wear of conventional and crosslinked polyethylene liners affected by ball diameter, rigidity of backing, and liner thickness? Are the stresses in the liner affected by thickness?MethodsWear rates were measured in a hip simulator and stresses were calculated using finite element modeling.ResultsWithout crosslinking, the wear rate was 4% to 10% greater with a 36-mm diameter than a 28-mm diameter. With crosslinking, wear was 9% lower with a 36-mm diameter without metal backing and 4% greater with metal backing. Reducing the thickness from 6 mm to 3 mm increased the contact stress by 46%, but the wear rate decreased by 19%.ConclusionsThe reduction in wear with 5 Mrad of crosslinking was not offset by increasing the diameter from 28 mm to 36 mm or by using a liner as thin as 3 mm.Clinical RelevanceThe results indicate, for a properly positioned 5-Mrad crosslinked acetabular component and within the range of dimensions evaluated, neither wear nor stresses in the polyethylene are limiting factors in the use of larger-diameter, thinner cups to resist dislocation.

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“…In a study by Tower et al. [12], they suggested that the minimum thickness at the equatorial region was the critical dimension with respect to liner failure. In their report, all 4 liners that cracked at the superior rim had a minimum rim thickness of <4 mm.…”

Section: Discussionmentioning

confidence: 99%

Superior rim fracture of a vitamin E-infused highly cross-linked polyethylene (HXLPE) liner leading to total hip arthroplasty revision

Brazier

Meško

2018

Arthroplasty Today

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This case report looks at the failure of a vitamin E-infused highly cross-linked polyethylene acetabular liner that fractured at the superior rim of the locking mechanism. This calls to question whether there is a problem with the vitamin E-infused product or a flaw in the design of the liner or possibly a combination of the 2. Although there has been discussion of a possible minimum rim polyethylene thickness, there has not been a minimum thickness established. In addition, in the case of offset liners, indentations which are a part of a locking mechanism can cause the minimum rim dimension to be much less than the specified nominal thickness. This case serves as an interesting observation and contributes to the discussion of rim liner polyethylene thickness and minimum rim thickness.

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Rim Cracking of the Cross-Linked Longevity Polyethylene Acetabular Liner After Total Hip Arthroplasty

Cited by 165 publications

References 12 publications

Crack Initiation in Retrieved Cross-Linked Highly Cross-Linked Ultrahigh-Molecular-Weight Polyethylene Acetabular Liners

Crack Initiation in Retrieved Cross-Linked Highly Cross-Linked Ultrahigh-Molecular-Weight Polyethylene Acetabular Liners

Wear versus Thickness and Other Features of 5-Mrad Crosslinked UHMWPE Acetabular Liners

Superior rim fracture of a vitamin E-infused highly cross-linked polyethylene (HXLPE) liner leading to total hip arthroplasty revision

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