Polyethylene wear in total hip arthroplasty.

Polyethylene wear increasingly has been blamed for osteolysis and granuloma formation after total joint arthroplasty. The authors evaluated the wear difference between bearing surfaces of stainless steel, cobalt chrome, and titanium alloy. They also compared cemented all-polyethylene molded cups with cemented metal-backed molded acetabular cups. These were compared with molded and machined polyethylene cups. Two patient groups were matched individually for gender, age, weight, and length of followup. Analyses were done using the technique of Livermore et al. The bearing surface evaluation consisted of 3 groups after matching, leaving 77 patients per group. Results showed linear wear rates of 0.06 mm per year, 0.05 mm per year, and 0.08 mm per year for stainless steel, cobalt chrome, and titanium alloy, respectively. The comparison between cemented molded metal-backed and nonmetal-backed acetabular components was not matched, with 134 metal-backed and 99 nonmetal-backed components. Results showed linear wear rates of 0.011 mm per year in the metal-backed group and 0.08 mm per year in the nonmetal-backed group. Results were statistically significant. These results indicate that the metal composition of the femoral bearing surface has minimal, if any, effect on the linear polyethylene wear rate. The method of polyethylene fabrication and the use of metal backing had a significant effect on the polyethylene wear rate in these patient groups. These results suggest that the compression-molded all-polyethylene acetabular component may be optimal for reducing polyethylene wear in total hip arthroplasty.