Clinical Orthopaedics and Related Research®

, Volume 469, Issue 2, pp 372–381 | Cite as

The Incidence of Acetabular Osteolysis in Young Patients With Conventional versus Highly Crosslinked Polyethylene

  • Nathan A. Mall
  • Ryan M. Nunley
  • Jin Jun Zhu
  • William J. Maloney
  • Robert L. Barrack
  • John C. ClohisyEmail author
Symposium: Papers Presented at the Hip Society Meetings 2010



Osteolysis is a major mode of hip implant failure. Previous literature has focused on the amount of polyethylene wear comparing highly crosslinked polyethylene (HXPLE) with conventional liners but has not clarified the relative incidence of osteolysis with these two liners.


We determined (1) the incidence of osteolysis in HXLPE versus conventional polyethylene (CPE), (2) the ability to detect and evaluate the size of lytic lesions using radiographs compared with CT scans, (3) head penetration in hips without and with lysis, and (4) determined whether acetabular position, head size, and UCLA activity score contributed to lysis.


We compared head penetration and osteolysis on plain radiographs and presence and volume of osteolysis on CT scans in 48 patients with HXLPE (mean, 46.5 years) and 50 patients with CPE (mean, 43.2 years). The minimum followup was 5 years (average, 7.2 years; range, 5.1–10.9 years),


Osteolysis was apparent on CT in a larger number of patients with CPE liners than HXLPE liners: 12 of 50 (24%) versus one of 48 (2%), respectively. We found no correlation between head penetration and volume of osteolytic lesions. Head penetration was greater in patients with osteolysis. Smaller head sizes were associated with greater wear and those with osteolysis had smaller head sizes; however, there was no difference in acetabular component position or UCLA activity in those with lysis compared with those without.


HXLPE diminished the incidence of osteolysis, but the lack of correlation between penetration and volume of osteolysis suggests other factors other than wear contribute to the development of osteolysis.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


Acetabular Component Osteolytic Lesion Head Size Lytic Lesion Acetabular Anteversion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Kirk E. Smith for his work with CT scan processing and measurement of these CT examinations.


  1. 1.
    Abu-Amer Y, Darwech I, Clohisy JC. Aseptic loosening of total joint replacements: mechanisms underlying osteolysis and potential therapies. Arthritis Res Ther. 2007;9(Suppl 1):S6.CrossRefPubMedGoogle Scholar
  2. 2.
    Ayers D, Hayes P, Drew J, Eskander M, Osuch D, Bragdon C. Two-year radiostereometric analysis evaluation of femoral head penetration in a challenging population of young total hip arthroplasty patients. J Arthroplasty. 2009;24(6 Suppl):9–14.CrossRefPubMedGoogle Scholar
  3. 3.
    Beaule PE, Dorey FJ, Hoke R, Leduff M, Amstutz HC. The value of patient activity level in the outcome of total hip arthroplasty. J Arthroplasty. 2006;21:547–552.CrossRefPubMedGoogle Scholar
  4. 4.
    Cahir JG, Toms AP, Marshall TJ, Wimhurst J, Nolan J. CT and MRI of hip arthroplasty. Clin Radiol. 2007;62:1163–1171; discussion 1172–1173.Google Scholar
  5. 5.
    Clohisy JC, Calvert G, Tull F, McDonald D, Maloney WJ. Reasons for revision hip surgery: a retrospective review. Clin Orthop Relat Res. 2004;429:188–192.CrossRefPubMedGoogle Scholar
  6. 6.
    D’Antonio JA, Manley MT, Capello WN, Bierbaum BE, Ramakrishnan R, Naughton M, Sutton K. Five-year experience with Crossfire highly cross-linked polyethylene. Clin Orthop Relat Res. 2005;441:143–150.CrossRefPubMedGoogle Scholar
  7. 7.
    Del Schutte H, Jr., Lipman AJ, Bannar SM, Livermore JT, Ilstrup D, Morrey BF. Effects of acetabular abduction on cup wear rates in total hip arthroplasty. J Arthroplasty. 1998;13:621–626.CrossRefPubMedGoogle Scholar
  8. 8.
    Digas G, Karrholm J, Thanner J, Malchau H, Herberts P. The Otto Aufranc Award. Highly cross-linked polyethylene in total hip arthroplasty: randomized evaluation of penetration rate in cemented and uncemented sockets using radiostereometric analysis. Clin Orthop Relat Res. 2004;429:6–16.CrossRefPubMedGoogle Scholar
  9. 9.
    Dorr LD, Wan Z, Shahrdar C, Sirianni L, Boutary M, Yun A. Clinical performance of a Durasul highly cross-linked polyethylene acetabular liner for total hip arthroplasty at five years. J Bone Joint Surg Am. 2005;87:1816–1821.CrossRefPubMedGoogle Scholar
  10. 10.
    Dowd JE, Sychterz CJ, Young AM, Engh CA. Characterization of long-term femoral-head-penetration rates. Association with and prediction of osteolysis. J Bone Joint Surg Am. 2000;82:1102–1107.PubMedGoogle Scholar
  11. 11.
    Dumbleton JH, Manley MT, Edidin AA. A literature review of the association between wear rate and osteolysis in total hip arthroplasty. J Arthroplasty. 2002;17:649–661.CrossRefPubMedGoogle Scholar
  12. 12.
    Elfick AP, Hall RM, Pinder IM, Unsworth A. Wear in retrieved acetabular components: effect of femoral head radius and patient parameters. J Arthroplasty. 1998;13:291–295.CrossRefPubMedGoogle Scholar
  13. 13.
    Endo M, Tipper JL, Barton DC, Stone MH, Ingham E, Fisher J. Comparison of wear, wear debris and functional biological activity of moderately crosslinked and non-crosslinked polyethylenes in hip prostheses. Proc Inst Mech Eng [H]. 2002;216:111–122.Google Scholar
  14. 14.
    Engh CA Jr, Stepniewski AS, Ginn SD, Beykirch SE, Sychterz-Terefenko CJ, Hopper RH Jr, Engh CA. A randomized prospective evaluation of outcomes after total hip arthroplasty using cross-linked marathon and non-cross-linked Enduron polyethylene liners. J Arthroplasty. 2006;21(Suppl 2):17–25.PubMedGoogle Scholar
  15. 15.
    Fisher J, McEwen HM, Tipper JL, Galvin AL, Ingram J, Kamali A, Stone MH, Ingham E. Wear, debris, and biologic activity of cross-linked polyethylene in the knee: benefits and potential concerns. Clin Orthop Relat Res. 2004;428:114–119.CrossRefPubMedGoogle Scholar
  16. 16.
    Gallo J, Havranek V, Zapletalova J. Risk factors for accelerated polyethylene wear and osteolysis in ABG I total hip arthroplasty. Int Orthop. 2010;34:19–26.CrossRefPubMedGoogle Scholar
  17. 17.
    Glyn-Jones S, Isaac S, Hauptfleisch J, McLardy-Smith P, Murray D, Gill H. Does highly cross-linked polyethylene wear less than conventional polyethylene in total hip arthroplasty? A double-blind, ransomized, and controlled trial using roentgen stereophotogrammetric analysis. J Arthroplasty. 2008;23:337–343.CrossRefPubMedGoogle Scholar
  18. 18.
    Gomez-Barrena E, Puertolas JA, Munuera L, Konttinen YT. Update on UHMWPE research: from the bench to the bedside. Acta Orthop. 2008;79:832–840.CrossRefPubMedGoogle Scholar
  19. 19.
    Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMedGoogle Scholar
  20. 20.
    Heisel C, Silva M, dela Rosa MA, Schmalzried TP. Short-term in vivo wear of cross-linked polyethylene. J Bone Joint Surg Am. 2004;86:748–751.PubMedGoogle Scholar
  21. 21.
    Heisel C, Silva M, Schmalzried TP. Bearing surface options for total hip replacement in young patients. Instr Course Lect. 2004;53:49–65.PubMedGoogle Scholar
  22. 22.
    Hermida JC, Bergula A, Chen P, Colwell CW Jr, D’Lima DD. Comparison of the wear rates of twenty-eight and thirty-two-millimeter femoral heads on cross-linked polyethylene acetabular cups in a wear simulator. J Bone Joint Surg Am. 2003;85:2325–2331.PubMedGoogle Scholar
  23. 23.
    Howie DW, Neale SD, Stamenkov R, McGee MA, Taylor DJ, Findlay DM. Progression of acetabular periprosthetic osteolytic lesions measured with computed tomography. J Bone Joint Surg Am. 2007;89:1818–1825.CrossRefPubMedGoogle Scholar
  24. 24.
    Hui AJ, McCalden RW, Martell JM, MacDonald SJ, Bourne RB, Rorabeck CH. Validation of two and three-dimensional radiographic techniques for measuring polyethylene wear after total hip arthroplasty. J Bone Joint Surg Am. 2003;85:505–511.PubMedGoogle Scholar
  25. 25.
    Kawamura H, Dunbar MJ, Murray P, Bourne RB, Rorabeck CH. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg Am. 2001;83:1333–1338.PubMedGoogle Scholar
  26. 26.
    Kitamura N, Leung SB, Engh CA, Sr. Characteristics of pelvic osteolysis on computed tomography after total hip arthroplasty. Clin Orthop Relat Res. 2005;441:291–297.CrossRefPubMedGoogle Scholar
  27. 27.
    Kitamura N, Naudie DD, Leung SB, Hopper RH Jr, Engh CA Sr. Diagnostic features of pelvic osteolysis on computed tomography: the importance of communication pathways. J Bone Joint Surg Am. 2005;87:1542–1550.CrossRefPubMedGoogle Scholar
  28. 28.
    Kitamura N, Pappedemos PC, Duffy PR III, Stepniewski AS, Hopper RH Jr, Engh CA Jr, Engh CA. The value of anteroposterior pelvic radiographs for evaluating pelvic osteolysis. Clin Orthop Relat Res. 2006;453:239–245.CrossRefPubMedGoogle Scholar
  29. 29.
    Lachiewicz PF, Heckman DS, Soileau ES, Mangla J, Martell JM. Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years. Clin Orthop Relat Res. 2009;467:3290–3296.CrossRefPubMedGoogle Scholar
  30. 30.
    Leung S, Naudie D, Kitamura N, Walde T, Engh CA. Computed tomography in the assessment of periacetabular osteolysis. J Bone Joint Surg Am. 2005;87:592–597.CrossRefPubMedGoogle Scholar
  31. 31.
    Leung SB, Egawa H, Stepniewski A, Beykirch S, Engh CA Jr, Engh CA Sr. Incidence and volume of pelvic osteolysis at early follow-up with highly cross-linked and noncross-linked polyethylene. J Arthroplasty. 2007;22(Suppl 2):134–139.CrossRefPubMedGoogle Scholar
  32. 32.
    Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990;72:518–528.PubMedGoogle Scholar
  33. 33.
    Martell JM, Berdia S. Determination of polyethylene wear in total hip replacements with use of digital radiographs. J Bone Joint Surg Am. 1997;79:1635–1641.PubMedGoogle Scholar
  34. 34.
    Martell JM, Berkson E, Berger R, Jacobs J. Comparison of two and three-dimensional computerized polyethylene wear analysis after total hip arthroplasty. J Bone Joint Surg Am. 2003;85:1111–1117.PubMedGoogle Scholar
  35. 35.
    McCalden R, MacDonald S, Rorabeck C, Bourne R, Chess D, Charron K. Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. 2009;91:773–782.CrossRefPubMedGoogle Scholar
  36. 36.
    Olyslaegers C, Defoort K, Simon JP, Vandenberghe L. Wear in conventional and highly cross-linked polyethylene cups: a 5-year follow-up study. J Arthroplasty. 2008;23:489–494.CrossRefPubMedGoogle Scholar
  37. 37.
    Oonishi H, Tsuji E, Kim Y. Retrieved total hip prostheses. Part 1: The effects of cup thickness, head sizes, and fusion defects on wear. J Mater Sci Mater Med. 1998;9:393–401.CrossRefPubMedGoogle Scholar
  38. 38.
    Orishimo KF, Claus AM, Sychterz CJ, Engh CA. Relationship between polyethylene wear and osteolysis in hips with a second-generation porous-coated cementless cup after seven years of follow-up. J Bone Joint Surg Am. 2003;85:1095–1099.PubMedGoogle Scholar
  39. 39.
    Puri L, Wixson RL, Stern SH, Kohli J, Hendrix RW, Stulberg SD. Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty. J Bone Joint Surg Am. 2002;84:609–614.PubMedGoogle Scholar
  40. 40.
    Schmalzried TP, Shepherd EF, Dorey FJ, Jackson WO, dela Rosa M, Fa’vae F, McKellop HA, McClung CD, Martell J, Moreland JR, Amstutz HC. The John Charnley Award. Wear is a function of use, not time. Clin Orthop Relat Res. 2000;381:36–46.CrossRefPubMedGoogle Scholar
  41. 41.
    Shia DS, Clohisy JC, Schinsky MF, Martell JM, Maloney WJ. THA with highly cross-linked polyethylene in patients 50 years of age or younger. Clin Orthop Relat Res. 2009;467:2059–2065.CrossRefPubMedGoogle Scholar
  42. 42.
    Shon WY, Gupta S, Biswal S, Han SH, Hong SJ, Moon JG. Pelvic osteolysis relationship to radiographs and polyethylene wear. J Arthroplasty. 2009;24:743–750.CrossRefPubMedGoogle Scholar
  43. 43.
    Soto MO, Rodriguez JA, Ranawat CS. Clinical and radiographic evaluation of the Harris-Galante cup: incidence of wear and osteolysis at 7 to 9 years follow-up. J Arthroplasty. 2000;15:139–145.CrossRefPubMedGoogle Scholar
  44. 44.
    Tarasevicius S, Robertsson O, Kesteris U, Kalesinskas RJ, Wingstrand H. Effect of femoral head size on polyethylene wear and synovitis after total hip arthroplasty: a sonographic and radiographic study of 39 patients. Acta Orthop. 2008;79:489–493.CrossRefPubMedGoogle Scholar
  45. 45.
    Udomkiat P, Dorr LD, Wan Z. Cementless hemispheric porous-coated sockets implanted with press-fit technique without screws: average ten-year follow-up. J Bone Joint Surg Am. 2002;84:1195–1200.PubMedGoogle Scholar
  46. 46.
    Walde TA, Mohan V, Leung S, Engh CA Sr. Sensitivity and specificity of plain radiographs for detection of medial-wall perforation secondary to osteolysis. J Arthroplasty. 2005;20:20–24.CrossRefPubMedGoogle Scholar
  47. 47.
    Walde TA, Weiland DE, Leung SB, Kitamura N, Sychterz CJ, Engh CA Jr, Claus AM, Potter HG, Engh CA Sr. Comparison of CT, MRI, and radiographs in assessing pelvic osteolysis: a cadaveric study. Clin Orthop Relat Res. 2005;437:138–144.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Nathan A. Mall
    • 1
  • Ryan M. Nunley
    • 1
  • Jin Jun Zhu
    • 1
  • William J. Maloney
    • 2
  • Robert L. Barrack
    • 1
  • John C. Clohisy
    • 1
    Email author
  1. 1.Department of OrthopedicsWashington University School of Medicine, Barnes-Jewish HospitalSt LouisUSA
  2. 2.Department of Orthopaedic SurgeryStanford University School of MedicineStanfordUSA

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