title: Correlation of wear debris-induced osteolysis and revision with volumetric wear-rates of polyethylene: a survey of 8 reports in the literature.
abstract: This survey focused on clinical reports of polyethylene wear and osteolysis in total hip replacements. With regard to documentation of clinical wear-rates, 57 publications were reduced to an analysis of 8 reports of THR series, including the incidence of osteolysis. A direct correlation was found among volumetric wear-rates, incidence of osteolysis and revision rates in THR concepts of the 1983-1987 era. As volumetric wear rate increased, the incidence of osteolysis and revision rates increased. With regard to our grading system for volumetric wear, with follow-up in the 4-15 year range, osteolysis was rare in group A (wear = 0-80 mm3/year), ranging from 6% to 31% in group B (wear 40-80 mm3/year) and from 21% to 100% in group C (wear > 140 mm3/year). With regard to cup design, the optimal low-wear group had mainly cemented polyethylene cups with 22 and 28 mm head sizes. The mid-wear group B had metal-backed cemented and uncemented cups, with 28 mm head size, and the high-risk group C had only uncemented, metal-backed cups, with the highest wear in the 32 mm head size. Less than 10 years of follow-up did not distinguish adequately between different designs of THR, except in a few cases which had early failures due to material or design deficiencies. Overall, the cemented all-polyethylene cup combined with the smaller ball head proved to be better.
authors.affiliation: Department of Orthopaedic Surgery, Institute of Surgical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: P C
authors.initials: PC
authors.lastname: Oparaugo
authors.forename: I C
authors.initials: IC
authors.lastname: Clarke
authors.forename: H
authors.initials: H
authors.lastname: Malchau
authors.forename: P
authors.initials: P
authors.lastname: Herberts
mesh_terms: D001843:Bone Cements / Q000627:therapeutic use; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000145:classification / Q000592:standards; D006801:Humans; D015994:Incidence; D010014:Osteolysis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D020959:Polyethylene / Q000009:adverse effects*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data* / Q000639:trends; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D020959:Polyethylene