Assessing the pattern of femoral head penetration after total hip arthroplasty

We evaluated temporal changes in wear rates among 205 primary cementless total hip arthroplasties that had minimum 10-year follow-up and at least 6 follow-up x-rays. Using the pelvic anteroposterior x-rays from each hip, two-dimensional head penetration was measured and wear rates were calculated using several techniques. The average wear rate for the study population did not demonstrate evidence of accelerated wear at 10- to 18-year follow-up. As an increasing number of follow-up x-rays were included in the least-squares linear regression used to calculate the wear rate, the 95% confidence interval associated with the wear rate for an individual hip tended to progressively decrease. These results indicate that a constant wear rate is a reasonable assumption for modeling clinical wear data. Although we cannot quantify the effects of polyethylene oxidation, femoral head roughening, debris accumulation, or activity level changes, the combination of these factors is not leading to clinically perceptible accelerated wear at intermediate to long-term follow-up in this heterogeneous population of cups representing our institutional experience.