Brian R. Burroughs

Femoral head sizes larger than 32 mm against highly cross-linked polyethylene.

The advent of highly cross-linked ultrahigh molecular weight polyethylene, which shows extremely low wear independent of head size in vitro, allows for the reevaluation of the use of femoral heads larger than 32 mm. The current authors discuss information that supports this hypothesis. The supporting information includes in vitro wear testing and in vitro anatomic studies, and prior clinical studies in which large femoral heads were used.

Knee simulator wear of polyethylene tibias articulating against explanted rough femoral components.

Highly cross-linked and melted polyethylene tibial inserts have recently been introduced for clinical use to reduce fatigue damage and adhesive wear in tibial inserts. Other authors have studied the effect of counterface roughness on the wear behavior of polyethylene tibial inserts in knee simulators using femoral components that were roughened artificially. They reported a higher wear rate with highly cross-linked polyethylene than with unirradiated polyethylene tibial inserts. Artificial roughening of femoral components may not be clinically relevant. To evaluate this concern, we studied the wear behavior of highly cross-linked and conventional polyethylene tibial inserts articulating in vitro against surgically retrieved femoral components that had become roughened in vivo. The wear rate of the highly cross-linked polyethylene (5.9 and 6.8 mg/1 million cycles with 100 and 50% serum) was 80% lower than the wear rate of the conventional polyethylene (33.5 and 32.2 mg/1 million cycles with 100 and 50% serum) tibial inserts after 2 million cycles of simulated gait. This study suggests that during in vivo use, scratches that are generated on the femoral components are likely to produce a higher wear rate with both cross-linked and conventional polyethylene than a smooth femoral component, but that this wear rate is likely to be higher with conventional polyethylene than with highly cross-linked polyethylene tibial inserts.

In vitro comparison of frictional torque and torsional resistance of aged conventional gamma-in-nitrogen sterilized polyethylene versus aged highly crosslinked polyethylene articulating against head sizes larger than 32 mm.

Background The advent of highly crosslinked polyethylene has allowed the re-evaluation of the use of femoral heads larger than 32 mm for metal-on-polyethylene total hip arthroplasties. However, the effect of larger heads on the frictional torque of highly crosslinked polyethylene is unknown. Methods We performed an in vitro examination of the effect of larger chrome cobalt femoral heads (40 mm diameter) on the frictional torque and torsional resistance of hip articulations on aged liners of polyethylene that were sterilized by gamma rays while in nitrogen, and aged highly crosslinked polyethylene. The frictional torque at the femoral head articulation was usually higher for the highly crosslinked polyethylene than for the conventional polyethylene. The aged conventional liners oxidized considerably, which led to gross failure of the polyethylene at the anti-rotation portion of the rim. The aged crosslinked polyethylene showed no such failures despite the higher frictional torque. Interpretation Our findings suggest that in terms of torsional resistance to fatigue when studied as a device, rather than as an isolated material, under these conditions, aged highly crosslinked polyethylene is preferable to aged conventional polyethylene.