Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty

• Published in: Journal of bone and joint surgery. American volume Vol. 89A; no. 10; pp. 2212 - 2217
• Main Authors: TOWER, Stephen S, CURRIER, John H, CURRIER, Barbara H, LYFORD, Kimberly A, VAN CITTERS, Douglas W, MAYOR, Michael B
• Format: Journal Article
• Language: English
• Published: Boston, MA Journal of Bone and Joint Surgery Incorporated 01-10-2007
• Subjects: Acetabulum; Arthroplasty, Replacement, Hip; Biological and medical sciences; Cross-Linking Reagents; Equipment Failure Analysis; Female; Hip Prosthesis; Humans; Injuries of the limb. Injuries of the spine; Joint Diseases - surgery; Medical sciences; Middle Aged; Orthopedic surgery; Polyethylene; Prosthesis Failure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents; Performance evaluation; Human; Hip prosthesis; Polyethylene; Orthopedic surgery; Treatment; Femoral head; Diseases of the osteoarticular system; Acetabulum; Fracture; Longevity; Trauma
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200710000-00016

Studies have suggested that cross-linked polyethylene bearings reduce wear rates from 40% to 100% compared with conventional polyethylene. However, the reduced mechanical properties of highly cross-linked polyethylene have the potential to be a limiting factor in device performance. We reviewed a series of retrieved acetabular liners with a fracture of the superior rim to assess the factors that played a role in their failure.
Four Longevity acetabular bearings, which had been retrieved from two patients after seven to twenty-seven months in vivo, were visually examined for clinical damage, were assessed with use of Fourier transform infrared spectroscopy to determine the level of oxidation, and were analyzed for mechanical properties and fracture surface characterization. Control data were obtained from never-implanted devices and from global reference ultrahigh molecular weight polyethylene bar stock as an industry calibration material.
All four retrieved liners demonstrated articular surface wear modes, which in most cases were rated as moderate, and none were rated as severe. All showed cracking or rim failure of the liner at the superior aspect along the groove in the polyethylene that engages the locking ring of the shell. The retrieved liners had no measurable oxidation, and the mechanical properties were comparable with those of never-implanted material.
There was no notable in vivo degradation of the retrieved liners. Important factors related to failure appear to be thin polyethylene at the cup rim, relatively vertical cup alignment, and the material properties of the highly cross-linked polyethylene that are decreased relative to conventional polyethylene. The critical dimension with respect to rim failure in modular liners appears to be the minimum thickness at the equatorial region.