title: Is the use of thin, highly cross-linked polyethylene liners safe in total hip arthroplasty?
abstract: OBJECTIVE
  Due to the high number of total hip arthroplasties (THA) revised due to instability, the use of large femoral heads to reduce instability is justifiable. It is critical to determine whether or not large femoral heads used in conjunction with thin polyethylene liners lead to increased wear rates, which can lead to osteolysis. Therefore, by using validated wear-analysis software, we evaluated linear wear rates in a consecutive cohort of patients who underwent primary THA with thin polyethylene liners.
  
  
  METHODS
  All patients were selected from a consecutive, prospectively collected database of 241 THAs performed at a single institution by two fellowship-trained joint-reconstruction surgeons between July 2007 and June 2011. These patients were 1:1 matched to a cohort of patients who had conventional-thickness polyethylene liners.
  
  
  RESULTS
  No significant differences were observed between linear wear rates of thin or conventional-thickness liners. The Kaplan-Meier survivorship for both cohorts was 100 %, and no cases of polyethylene fracture were observed in either cohort.
  
  
  CONCLUSIONS
  Our results suggest that according to a mean follow-up of 4 years, the use of thin liners in THA is promising. Longer follow-up is required to assess whether these outcomes are observed later.
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
authors.forename: Julio J
authors.initials: JJ
authors.lastname: Jauregui
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Qais
authors.initials: Q
authors.lastname: Naziri
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Pierce
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
authors.forename: Randa K
authors.initials: RK
authors.lastname: Elmallah
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Cherian
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Delanois
authors.affiliation: Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA. mmont@lifebridgehealth.org.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D005270:Femur Head / Q000601:surgery*; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020959:Polyethylene / Q000627:therapeutic use*; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016019:Survival Analysis
chemical_list: D003432:Cross-Linking Reagents; D020959:Polyethylene
keywords: Large femoral heads; Polyethylene wear; Prosthetic stability; Radiographic analysis; Thin polyethylene liners; Total hip arthroplasty