Abstract
Objective: Selection of articulating surface combinations for primary total hip arthroplasty is controversial. This debate demonstrates that a highly crosslinked ultrahigh molecular weight polyethylene socket with a metal femoral head is better than metal on metal or ceramic on ceramic articulating surfaces for total arthroplasty, following our published results and other papers.
Since Sir John Charnley first reported it, ultra high molecular weight polyethylene has shown better wear performance than many other materials. Collier reported that gamma-sterilized polyethylene tended to oxidize near the surface, with features such as white bands, with long shelf storage. McKellop noted that crosslinking without any free radicals in polyethylene crystal lesion gave extremely low wear rates, compared to oxidized conventional polyethylene. Metal on metal has several problems such as metal ion release, allergy, and dissemination to other organs. Ceramic on ceramic showed “chipping”, breakage, and bad conformity at revision surgery for metal-backed acetabular cups and femoral necks. Highly crosslinked polyethylene without free radicals showed very good wear performance in hip simulator studies, but clinical long-term results were unknown.
Our aim here is to evaluate long-term clinical results using randomized prospective well-controlled studies, regarding which articulating surface is best for longevity of primary total hip arthroplasty.
