Wear of Polyethylene Cups in Total Hip Arthroplasty. A Study of Specimens Retrieved Post Mortem*

Sychterz, Christi J.; Moon, Kyoung Ho; Hashimoto, Yashushi; Terefenko, Kevin M.; Engh, C. Anderson; Bauer, Thomas W.

doi:10.2106/00004623-199608000-00009

Cited by 119 publications

(68 citation statements)

References 11 publications

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“…Isaac et al (1992) showed an acetabular liner that had both impingement damage ("rim wear") and particles on the liner surface ("cement ingress"), but they did not explicitly connect these two phenomena. Sychterz et al (1996) found that polyethylene liners with embedded debris corresponded to femoral heads that had almost 70% higher mean surface roughness than those without embedded debris, and that wear of the debris-embedded polyethylene liners was significantly higher than for otherwise similar liners in that study. Also, Kim et al (2005) found that increased surface roughness of the femoral head and presence of embedded debris in the acetabular liner were both associated with increased wear, and that the surface roughness of femoral components increased due to metal transfer onto ceramic femoral heads.…”

Section: Discussionmentioning

confidence: 54%

“…There is ample documentation of third body particles embedded in retrieved acetabular liners (Bloebaum et al, 1997;Isaac et al, 1992;Kim et al, 2005;Lundberg et al, 2007a;Shon et al, 2005;Sychterz et al, 1996). Lundberg et al (2007a) found that acetabular liners with impingement damage were significantly more likely to have embedded debris, and that liners with higher grades of impingement damage were increasingly more likely to have embedded debris.…”

Section: Discussionmentioning

confidence: 99%

“…Tribologically, even minimal scratching of a metallic articular surface can result in severe wear rate increase of polyethylene (Dowson et al, 1987). Third body particles embedded in polyethylene acetabular components are a well-documented finding in retrieval studies (Bloebaum et al, 1997;Isaac et al, 1992;Kim et al, 2005;Lundberg et al, 2007a;Shon et al, 2005;Sychterz et al, 1996), and are therefore suspected of contributing to the intra-cohort variability of wear (Joshi et al, 2001;Orishimo et al, 2003), even for bearing combinations that have relatively low cohort-average wear rates.…”

Section: Introductionmentioning

confidence: 99%

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Effects of episodic subluxation events on third body ingress and embedment in the THA bearing surface

Heiner

Baer

Pedersen

et al. 2008

Journal of Biomechanics

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In total joint arthroplasty, third body particle access to the articulating surfaces results in accelerated wear. Hip joint subluxation is an under-recognized means by which third body particles could potentially enter the otherwise closely conforming articular bearing space. The present study was designed to test the hypothesis that, other factors being equal, even occasional events of femoral head subluxation greatly increase the number of third body particles that enter the bearing space and become embedded in the acetabular liner, as compared to level walking cycles alone. Ten metal-onpolyethylene hip joint head-liner pairs were tested in a multi-axis joint motion simulator, with CoCrMo third body particles added to the synovial fluid analog. All component pairs were tested for two hours of level walking; half also were subjected to twenty intermittent subluxation events. The number and location of embedded particles on the acetabular liners were then determined. Subluxation dramatically increased the number of third body particles embedded in the acetabular liners, and it considerably increased the amount of scratch damage on the femoral heads. Since both third body particles and subluxation frequently occur in contemporary total hip arthroplasty, their potent synergy needs to be factored prominently into strategies to minimize wear.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of episodic subluxation events on third body ingress and embedment in the THA bearing surface

Heiner

Baer

Pedersen

et al. 2008

Journal of Biomechanics

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“…Exclusion of patients with low activity increased the global wear rate to 47 mm 3 per year, which is within this published range (Table 3). The corresponding linear wear rate of 0.11 mm per year also was in the range of 0.07 to 1.6 mm per year reported for HG and HG II components retrieved at revision (Table 3) [7,10,23,25,34]. The absence of delamination on the articulating surface can be explained by the low contact stresses produced by the highly congruent contact of THRs.…”

Section: Discussionmentioning

confidence: 57%

“…This outcome is not surprising for the tibial inserts because the MG II design exhibits low conformity and to a large extent, backside wear in TKRs is strongly associated with high-conformity tibial inserts [38]. The mean wear rate of 38 mm 3 per year for the entire THR group was slightly less than the range of 40 to 83 mm 3 per year previously reported for historical PE of that generation, GUR 4150 gamma-sterilized in air [25,34]. Exclusion of patients with low activity increased the global wear rate to 47 mm 3 per year, which is within this published range (Table 3).…”

Section: Discussionmentioning

confidence: 91%

How Does Wear Rate Compare in Well-functioning Total Hip and Knee Replacements? A Postmortem Polyethylene Liner Study

Pourzal

Knowlton

Hall

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The longevity of total hip (THR) and knee replacements (TKR) that used historical bearing materials of gamma-in-air sterilized UHMWPE was affected more by osteolysis in THRs than in TKRs, although osteolysis remains a concern in TKRs. Therefore, the study of polyethylene wear is still of interest for the knee, particularly because few studies have investigated volumetric material loss in tibial knee inserts. For this study, a unique collection of autopsy-retrieved TKR and THR components that were well-functioning at the time of retrieval was used to compare volumetric wear differences between hip and knee polyethylene components made from identical material. Questions/purposes The following questions were addressed: (1) How much did the hip liners wear and what wear patterns did they exhibit? (2) How much did the knee inserts wear and what wear patterns did they exhibit? (3) What is the ratio between TKR and THR wear after controlling for implantation time and patient age? Methods We compared 23 THR components (HarrisGalante [HG] and HG II) and 20 TKR components (MillerGalante [MG II]) that were retrieved postmortem. The components were made from the same polyethylene formulation and with similar manufacturing and sterilization (gamma-in-air) processes. Twenty-one patients (12 males, nine females) had THRs and 16 (four males, 12 females) had TKRs. Patients who had TKRs had an older (p = 0.001) average age than patients who had THRs (age, 75 years; SD, 10, versus 66 years; SD, 12, respectively). Only wellfunctioning components were included in this study. Therefore, implants retrieved postmortem from physically active patients and implanted for at least 2 years were considered. In addition, only normally wearing TKR components were considered, ie, those with fatigue wear (delamination) were excluded. The wear volume of each component was measured using metrology. For the tibial inserts an autonomous mathematic reconstruction method was used for quantification. Results The acetabular liners of the THR group had a wear rate of 38 mm 3 per year (95% CI, 29-47 mm 3 /year). Excluding patients with low-activity, the wear rate was 47 mm 3 per year (95% CI, 37-56 mm 3 /year). The wear rate of normally wearing tibial inserts was 17 mm 3 per year (95% CI, À6 to 40 mm 3 /year). After controlling for the relevant confounding variable of age, we found a TKR/THR wear rate ratio of 0.5 (95% CI, 0.29-0.77) at 70 years of age with a slightly increasing difference with increasing age. Conclusions Excluding delamination, TKRs exhibited lower articular wear rates than THRs for historical polyethylene in these two unique cohorts of postmortem retrievals.

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Effect of femoral head diameter on tissue concentration of wear debris

Hirakawa

Bauer

Hashimoto

et al. 1997

J. Biomed. Mater. Res.

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Although several studies have reported the physical properties of debris particles in tissues adjacent to failed total joint implants, few have correlated the results of particle analysis with other clinical and implant variables believed to influence implant wear. We retrospectively analyzed 41 fibrous membranes (from 35 patients) adjacent to failed acetabular cups from a single manufacturer and studied the relationship between three different femoral head sizes (26, 28, and 32 mm) and the characteristics of wear debris in the adjacent tissues. All total hip prostheses consisted of modular cobalt-chromium alloy femoral heads articulating with titanium-alloy-backed ultrahigh molecular weight polyethylene (UHMWPE) acetabular components from a single manufacturer. Large femoral head diameter (32 mm) was found to correlate significantly with large particle size (diameter and surface area, p < 0.05), high tissue concentration of particles (particle volume/gram of tissue, p < 0.01), and high rate of particle production (particles volume/month, p < 0.05). The results of these quantitative assays support the findings of radiographically based clinical studies that show higher volumetric wear associated with 32 mm femoral head components.

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Wear of Polyethylene Cups in Total Hip Arthroplasty. A Study of Specimens Retrieved Post Mortem*

Cited by 119 publications

References 11 publications

Effects of episodic subluxation events on third body ingress and embedment in the THA bearing surface

Effects of episodic subluxation events on third body ingress and embedment in the THA bearing surface

How Does Wear Rate Compare in Well-functioning Total Hip and Knee Replacements? A Postmortem Polyethylene Liner Study

Effect of femoral head diameter on tissue concentration of wear debris

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