Goodman, S. Polyethylene - The hip: Long term results. Transactions of the 3rd UHMWPE International Meeting, Polyethylene in Total Joint Replacement Systems: Concerns and Solutions. Madrid, Spain, September 14-15, 2007.

Abstract
The major problem limiting the longevity of total hip replacements is polyethylene wear and the biological effects of wear particles generated at the articulation. As patients live longer and are more physically active, the demand for increased durability of total hip replacements is increasing. Conventional polyethylene was traditionally sterilized with gamma irradiation in air and therefore only moderately cross-linked. This lead to increased oxidation and wear of the plastic, especially in young active patients. The introduction of highly cross-linked polyethylene has attempted to solve the problem of increased wear. Volumetric wear of conventional polyethylene is about 30-120 mm3/year. Volumetric wear of highly cross-linked polyethylene is significantly less, about 17 mm3/year. Short-term clinical studies have substantiated these findings. Most recent clinical studies show a decrease in linear wear by about 45%-60% at 4-5 years post-operatively. These findings have prompted the use of larger femoral heads that may decrease linear wear and the dislocation rate, but are associated with an increase in volumetric wear. Furthermore, highly cross-linked polyethylene is generally more expensive than conventional polyethylene. Long-term clinical follow-up is needed to establish the durability of highly cross-linked polyethylene, and determine a viable cost-benefit analysis, especially in conjunction with larger diameter femoral heads so as to guide use.

Key Words: UHMWPE, wear, osteolysis, wear rate, crosslinked UHMWPE, review

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Radiograph demonstrating pelvic osteolysis around the patients right acetabular component.

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