Abstract
Periacetabular osteolysis in association with well-fixed cementless components was first recognised as a serious clinical problem in the early 1990s. By the mid-1990s, revision surgery for pelvic osteolysis secondary to polyethylene wear was the most common revision hip procedure performed. As a result, new bearing surfaces were introduced in hopes of reducing wear volume and thus reducing pelvic osteolysis. These included highly crosslinked polyethylene, ceramic-on-ceramic and metal-on-metal bearing surfaces.
Metal-on-metal has for the most part been eliminated in conventional hip replacement because of the concerns centered around adverse local tissue reactions. Both highly crosslinked polyethylene and ceramic-on-ceramic bearings have been successful in limiting wear and all but eliminating clinically significant osteolysis. Multiple reports on highly crosslinked polyethylene have documented wear rates below the lysis threshold. No reports of revision for wear have been reported despite twenty years of in-vivo use. Of import to the surgeons, all manufacturers commonly used in North America have performed well. In addition, highly crosslinked polyethylene has been relatively insensitive to head size allowing the use of 36mm femoral heads routinely. Similar reports are noted with ceramic-on-ceramic bearings. However, highly crosslinked has dominated the North American market because it is a relatively forgiving bearing surface and comes at a lower cost. Currently, there is a trend towards the use of ceramic femoral heads – not because of wear concerns, but concerns related to taper corrosion and large cobalt-chrome femoral heads.
