Retrieved highly crosslinked UHMWPE acetabular liners have similar wear damage as conventional UHMWPE.
BACKGROUND
Highly crosslinked UHMWPE is associated with increased wear resistance in hip simulator and clinical studies. Laboratory and case studies, however, have described rim fracture in crosslinked acetabular liners. Controversy exists, therefore, on the relative merits of crosslinked liners over conventional liners in terms of wear performance versus resistance to fatigue cracking.


OBJECTIVE
We asked whether crosslinked liners would show less surface damage than conventional liners but would be more susceptible to fatigue damage.


METHODS
We examined 36 conventional UHMWPE and 39 crosslinked UHMWPE retrieved implants with similar patient demographics and identical design for evidence of wear damage, including articular surface damage, impingement, screw-hole creep, and rim cracks.


RESULTS
We observed no difference in wear damage scores for the two liners. Conventional liners more frequently impinged but were more often elevated with smaller head sizes. We observed creep in approximately 70% of both types of liners. Incipient rim cracks were found in five crosslinked liners, and one liner had a rim fracture. Only one conventional liner had an incipient rim crack.


CONCLUSIONS
Contrary to our expectation, damage was similar between crosslinked and conventional UHMWPE liners. Moreover, the 15% occurrence (six of 39) of incipient or complete fractures in crosslinked liners as compared with a 3% occurrence (one of 36) in conventional liners may have implications for the long-term performance of crosslinked liners. Longer-term studies will be necessary to establish the fate of rim cracks and thus the overall clinical fatigue performance of crosslinked liners.
Schroder
David T
DT
Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY 10021, USA.
Kelly
Natalie H
NH
Wright
Timothy M
TM
Parks
Michael L
ML
D000077:Acetabulum / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D003432:Cross-Linking Reagents / Q000737:chemistry; D005260:Female; D006621:Hip Joint / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011095:Polyethylenes; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D013314:Stress, Mechanical; D013499:Surface Properties; D055815:Young Adult
D003432:Cross-Linking Reagents; D011095:Polyethylenes; C111601:ultra-high molecular weight polyethylene