Skip to main content

Advertisement

Log in

Initial increased wear debris of XLPE-Al2O3 bearing in total hip arthroplasties

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Aseptic implant loosening caused by wear debris is a common reason for early implant failure after total hip replacement (THR).

Materials and methods

We prospectively studied 96 patients (110 hips), 48 men and 48 women (mean age 46.8 years, mean body mass index 26.1) who had undergone cementless THR (titanium stem, press-fit cup, Al2O3 ball, XLPE liner) at a mean of 17.4 months (SD 13.4).

Results

The semi-computerized evaluation of wear rate showed wear of 0.25 mm (SD 0.3) corresponding to a volume of 97.6 mm3 (SD 121.1) during the first year. It was remarkable that the annual rate of wear was significantly lower in the second year: 0.14 mm (SD 0.1), 60.0 mm3 (SD 78.7). The implant survival rate was 100%. However, two patients underwent revision surgery.

Interpretation

Good, early functionality can be achieved by a cementless THR including a modular stem and a XLPE-Al2O3 bearing system. The rate of wear debris for XLPE-Al3O2 was much higher than expected within the first year after THR. However, after the initial running-in period a significant decrease of wear was documented, suggesting a biphasic abrasion [0.38 mm (SD 0.2) within the first year vs. 0.14 mm (SD 0.1)] after the running-in-period 1 year following surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kim WY, Greidanus NV, Duncan CP, Masri BA, Garbuz DS (2008) Porous tantalum uncemented acetabular shells in revision total hip replacement: two to four year clinical and radiographic results. Hip Int 18:17–22

    CAS  PubMed  Google Scholar 

  2. McLaughlin JR, Lee KR (1997) Total hip arthroplasty with an uncemented femoral component. Excellent results at ten-year follow-up. J Bone Joint Surg Br 79:900–907

    Article  CAS  PubMed  Google Scholar 

  3. Reigstad O, Siewers P, Rokkum M, Espehaug B (2008) Excellent long-term survival of an uncemented press-fit stem and screw cup in young patients: follow-up of 75 hips for 15–18 years. Acta Orthop 79:194–202

    Article  PubMed  Google Scholar 

  4. Siegmeth A, Duncan CP, Masri BA, Kim WY, Garbuz DS (2009) Modular tantalum augments for acetabular defects in revision hip arthroplasty. Clin Orthop Relat Res 467:199–205

    Article  PubMed  Google Scholar 

  5. Holt G, Murnaghan C, Reilly J, Meek RM (2007) The biology of aseptic osteolysis. Clin Orthop Relat Res 460:240–252

    CAS  PubMed  Google Scholar 

  6. Landgraeber S, von Knoch M, Loer F, Wegner A, Tsokos M, Hussmann B, Totsch M (2008) Extrinsic and intrinsic pathways of apoptosis in aseptic loosening after total hip replacement. Biomaterials 29:3444–3450

    Article  CAS  PubMed  Google Scholar 

  7. Lenz R, Mittelmeier W, Hansmann D, Brem R, Diehl P, Fritsche A, Bader R (2009) Response of human osteoblasts exposed to wear particles generated at the interface of total hip stems and bone cement. J Biomed Mater Res A 89:370–378

    PubMed  Google Scholar 

  8. Germain MA, Hatton A, Williams S, Matthews JB, Stone MH, Fisher J, Ingham E (2003) Comparison of the cytotoxicity of clinically relevant cobalt–chromium and alumina ceramic wear particles in vitro. Biomaterials 24:469–479

    Article  CAS  PubMed  Google Scholar 

  9. Green TR, Fisher J, Matthews JB, Stone MH, Ingham E (2000) Effect of size and dose on bone resorption activity of macrophages by in vitro clinically relevant ultra high molecular weight polyethylene particles. J Biomed Mater Res 53:490–497

    Article  CAS  PubMed  Google Scholar 

  10. Ingham E, Fisher J (2000) Biological reactions to wear debris in total joint replacement. Proc Inst Mech Eng [H] 214:21–37

    CAS  Google Scholar 

  11. Kobayashi A, Bonfield W, Kadoya Y, Yamac T, Freeman MA, Scott G, Revell PA (1997) The size and shape of particulate polyethylene wear debris in total joint replacements. Proc Inst Mech Eng [H] 211:11–15

    CAS  Google Scholar 

  12. Purdue PE, Koulouvaris P, Nestor BJ, Sculco TP (2006) The central role of wear debris in periprosthetic osteolysis. Hss J 2:102–113

    Article  PubMed  Google Scholar 

  13. Affatato S, Bersaglia G, Rocchi M, Taddei P, Fagnano C, Toni A (2005) Wear behaviour of cross-linked polyethylene assessed in vitro under severe conditions. Biomaterials 26:3259–3267

    Article  CAS  PubMed  Google Scholar 

  14. Tsukamoto R, Williams PA, Shoji H, Hirakawa K, Yamamoto K, Tsukamoto M, Clarke IC (2008) Wear of sequentially enhanced 9-Mrad polyethylene in 10 million cycle knee simulation study. J Biomed Mater Res B Appl Biomater 86:119–124

    PubMed  Google Scholar 

  15. Semlitsch M, Willert HG (1997) Clinical wear behaviour of ultra-high molecular weight polyethylene cups paired with metal and ceramic ball heads in comparison to metal-on-metal pairings of hip joint replacements. Proc Inst Mech Eng [H] 211:73–88

    CAS  Google Scholar 

  16. Tateiwa T, Clarke IC, Williams PA, Garino J, Manaka M, Shishido T, Yamamoto K, Imakiire A (2008) Ceramic total hip arthroplasty in the United States: safety and risk issues revisited. Am J Orthop 37:E26–E31

    PubMed  Google Scholar 

  17. Fisher J, Jin Z, Tipper J, Stone M, Ingham E (2006) Tribology of alternative bearings. Clin Orthop Relat Res 453:25–34

    Article  PubMed  Google Scholar 

  18. Olyslaegers C, Defoort K, Simon JP, Vandenberghe L (2008) Wear in conventional and highly cross-linked polyethylene cups: a 5-year follow-up study. J Arthroplasty 23:489–494

    Article  PubMed  Google Scholar 

  19. Hui AJ, McCalden RW, Martell JM, MacDonald SJ, Bourne RB, Rorabeck CH (2003) Validation of two and three-dimensional radiographic techniques for measuring polyethylene wear after total hip arthroplasty. J Bone Joint Surg Am 85-A:505–511

    PubMed  Google Scholar 

  20. Looney RJ, Boyd A, Totterman S, Seo GS, Tamez-Pena J, Campbell D, Novotny L, Olcott C, Martell J, Hayes FA, O’Keefe RJ, Schwarz EM (2002) Volumetric computerized tomography as a measurement of periprosthetic acetabular osteolysis and its correlation with wear. Arthritis Res 4:59–63

    Article  PubMed  Google Scholar 

  21. Martell JM, Berdia S (1997) Determination of polyethylene wear in total hip replacements with use of digital radiographs. J Bone Joint Surg Am 79:1635–1641

    CAS  PubMed  Google Scholar 

  22. Martell JM, Leopold SS, Liu X (2000) The effect of joint loading on acetabular wear measurement in total hip arthroplasty. J Arthroplasty 15:512–518

    Article  CAS  PubMed  Google Scholar 

  23. Gruen TA, McNeice GM, Amstutz HC (1979) E. Clin Orthop Relat Res 141:17–27

    Google Scholar 

  24. DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res:20–32

  25. Maxian TA, Brown TD, Pedersen DR, Callaghan JJ (1996) A sliding-distance-coupled finite element formulation for polyethylene wear in total hip arthroplasty. J Biomech 29:687–692

    Article  CAS  PubMed  Google Scholar 

  26. Miyanishi K, Hara T, Kaminomachi S, Maekawa M, Iwamoto M, Torisu T (2008) Short-term wear of Japanese highly cross-linked polyethylene in cementless THA. Arch Orthop Trauma Surg 128:995–1000

    Article  PubMed  Google Scholar 

  27. Glyn-Jones S, McLardy-Smith P, Gill HS, Murray DW (2008) The creep and wear of highly cross-linked polyethylene: a three-year randomised, controlled trial using radiostereometric analysis. J Bone Joint Surg Br 90:556–561

    Article  CAS  PubMed  Google Scholar 

  28. Bitsch RG, Loidolt T, Heisel C, Ball S, Schmalzried TP (2008) Reduction of osteolysis with use of Marathon cross-linked polyethylene. A concise follow-up, at a minimum of five years, of a previous report. J Bone Joint Surg Am 90:1487–1491

    Article  PubMed  Google Scholar 

  29. Jacobs CA, Christensen CP, Greenwald AS, McKellop H (2007) Clinical performance of highly cross-linked polyethylenes in total hip arthroplasty. J Bone Joint Surg Am 89:2779–2786

    Article  PubMed  Google Scholar 

  30. Krushell RJ, Fingeroth RJ, Cushing MC (2005) Early femoral head penetration of a highly cross-linked polyethylene liner vs a conventional polyethylene liner: a case-controlled study. J Arthroplasty 20:73–76

    Article  PubMed  Google Scholar 

  31. McCalden RW, Naudie DD, Yuan X, Bourne RB (2005) Radiographic methods for the assessment of polyethylene wear after total hip arthroplasty. J Bone Joint Surg Am 87:2323–2334

    Article  PubMed  Google Scholar 

  32. Estok DM II, Bragdon CR, Plank GR, Huang A, Muratoglu OK, Harris WH (2005) The measurement of creep in ultrahigh molecular weight polyethylene: a comparison of conventional versus highly cross-linked polyethylene. J Arthroplasty 20:239–243

    Article  PubMed  Google Scholar 

  33. Goldsmith AA, Dowson D, Wroblewski BM, Siney PD, Fleming PA, Lane JM (2001) The effect of activity levels of total hip arthroplasty patients on socket penetration. J Arthroplasty 16:620–627

    Article  CAS  PubMed  Google Scholar 

  34. Heisel C, Silva M, dela Rosa MA, Schmalzried TP (2004) Short-term in vivo wear of cross-linked polyethylene. J Bone Joint Surg Am 86-A:748–751

    PubMed  Google Scholar 

  35. Manning DW, Chiang PP, Martell JM, Galante JO, Harris WH (2005) In vivo comparative wear study of traditional and highly cross-linked polyethylene in total hip arthroplasty. J Arthroplasty 20:880–886

    Article  PubMed  Google Scholar 

  36. Engh CA Jr, Stepniewski AS, Ginn SD, Beykirch SE, Sychterz-Terefenko CJ, Hopper RH Jr, Engh CA (2006) A randomized prospective evaluation of outcomes after total hip arthroplasty using cross-linked marathon and non-cross-linked Enduron polyethylene liners. J Arthroplasty 21:17–25

    Article  PubMed  Google Scholar 

  37. Hopper RH Jr, Young AM, Orishimo KF, McAuley JP (2003) Correlation between early and late wear rates in total hip arthroplasty with application to the performance of marathon cross-linked polyethylene liners. J Arthroplasty 18:60–67

    Article  PubMed  Google Scholar 

  38. Shorez JP, Harding TS, Atkinson PJ, Walter N (2008) Alteration of the amount and morphology of wear particles by the addition of loading profile transitions during artificial hip wear testing. Proc Inst Mech Eng [H] 222:865–875

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marcus Jäger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jäger, M., Behringer, M., Zilkens, C. et al. Initial increased wear debris of XLPE-Al2O3 bearing in total hip arthroplasties. Arch Orthop Trauma Surg 130, 1481–1486 (2010). https://doi.org/10.1007/s00402-010-1061-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-010-1061-z

Keywords

Navigation