More than 50% reduction of wear in polyethylene liners with alumina heads compared to cobalt-chrome heads in hip replacements

Department of Orthopaedics , Ringerike Hospital , Hønefoss.
Acta Orthopaedica (Impact Factor: 2.77). 06/2013; 84(4). DOI: 10.3109/17453674.2013.810516
Source: PubMed


Background and purpose
Excessive wear of acetabular liners in hip replacements may lead to osteolysis and cup loosening. Different head materials are currently used. We measured differences in wear between alumina and cobalt-chrome heads with the same polyethylene liner.

Patients and methods
39 patients (43 hips) with osteoarthritis were included in a study with 10-year follow-up. Wear was measured as proximal and 3D penetration of the head in the liner with radiostereometry (RSA). All the patients were followed clinically with Harris hip score (HHS) for up to 10 years. Radiolucent lines and osteolytic lesions were assessed on plain radiographs.

With alumina heads, proximal wear (95% CI) after 10 years was 0.62 (0.44–0.80) mm as compared to 1.40 (1.00–1.80) mm in the cobalt-chrome group. For 3D wear, the results were 0.87 (0.69–1.04) mm for alumina heads and 1.78 (1.35–2.21) mm for cobalt-chrome heads. Median (range) HHS was 98 (77–100) in the alumina group and it was 93 (50–100) in the cobalt-chrome group (p = 0.01). We found no difference in osteolysis between the groups.

We found better wear properties with alumina heads than with cobalt-chrome heads. We recommend the use of alumina heads in patients in whom a high wear rate might be anticipated.

Download full-text


Available from: Lars Nordsletten
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and purpose Uncemented acetabular components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the second decade in young and active patients. We report on a minimum 10-year follow-up of an uncemented press-fit acetabular component that is still in clinical use. Methods We examined the clinical and radiographic results of our first 121 consecutive cementless THAs using a cementless, grit-blasted, non-porous, titanium alloy press-fit cup (Allofit; Zimmer Inc., Warsaw, IN) without additional screw fixation in 116 patients. Mean age at surgery was 51 (21–60) years. Mean time of follow-up evaluation was 11 (10–12) years. Results At final follow-up, 8 patients had died (8 hips), and 1 patient (1 hip) was lost to follow-up. 3 hips in 3 patients had undergone acetabular revision, 2 for deep infection and 1 for aseptic acetabular loosening. There were no impending revisions at the most recent follow-up. We did not detect periacetabular osteolysis or loosening on plain radiographs in those hips that were evaluated radiographically (n = 90; 83% of the hips available at a minimum of 10 years). Kaplan-Meier survival analysis using revision of the acetabular component for any reason (including isolated inlay revisions) as endpoint estimated the 11-year survival rate at 98% (95% CI: 92–99). Interpretation Uncemented acetabular fixation using the Allofit press-fit cup without additional screws was excellent into early in the second decade in this young and active patient cohort. The rate of complications related to the liner and to osteolysis was low.
    Full-text · Article · May 2014 · Acta Orthopaedica
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The use of highly crosslinked polyethylene (HXLPE) is now commonplace for total hip arthroplasty. Hip simulator studies and short-term in vivo measurements suggest that the wear rate of some types of HXLPE is significantly less than conventional ultrahigh-molecular-weight polyethylene (UHMWPE). However, there are few long-term data to support its use. Questions/purposes The aim of this study was to measure the long-term steady-state wear of HXLPE compared with UHMWPE liners in a prospective, double-blind, randomized controlled trial using radiostereometric analysis. Methods Fifty-four patients were randomized to receive hip arthroplasties with either UHMWPE liners or HXLPE liners. Complete followup was available on 39 of these patients (72%). All patients received the same cemented stem and an uncemented acetabular component. Three-dimensional penetration of the head into the socket was determined at 10 years using a radiostereometric analysis system, which has an in vivo accuracy of
    Full-text · Article · Aug 2014 · Clinical Orthopaedics and Related Research
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aseptic loosening as a result of wear debris is considered to be the main cause of long-term implant failure in orthopaedic surgery and improved biomaterials for bearing surfaces decreases significantly the release of micrometric wear particles. Increasingly, in-depth knowledge of osteoimmunology highlights the role of nanoparticles and ions released from some of these new bearing couples, opening up a new era in the comprehension of aseptic loosening. Mouse models have been essential in the progress made in the early comprehension of pathophysiology and in testing new therapeutic agents for particle-induced osteolysis. However, despite this encouraging progress, there is still no valid clinical alternative to revision surgery. The present review provides an update of the most commonly used bearing couples, the current concepts regarding particle-cell interactions and the approaches used to study the biology of periprosthetic osteolysis. It also discusses the contribution and future challenges of mouse models for successful translation of the preclinical progress into clinical applications.
    Full-text · Article · Sep 2014 · Clinical Science
Show more

We use cookies to give you the best possible experience on ResearchGate. Read our cookies policy to learn more.