Can Polyethylene Wear Be Decreased?

The enduring success of the low-friction arthroplasty advanced by Sir John Charnley as a solution for hip arthrosis may be appreciated by the fact that more than 800,000 primary and revision hip and knee arthroplasties were performed in 2003 in the United States. Despite this success, the advent of wear debris generation leading to osteolysis, fixation failure and fracture is of growing concern with the increased activity levels and aging of our society. Alternative bearing materials have had a checkered past as they moved from the laboratory to clinical application. Contemporarily highly cross-linked PEs and altered bearing surfaces have been introduced with the approval of the Food and Drug Administration in the absence of clinical data supporting their safety and effectiveness. It is no small coincidence that almost 59% of all PE acetabular components sold in the US today are constituted of highly cross-linked PEs in their various formulations. Their proclaimed advantage lies in the reduction of wear debris generation through enhanced cross-linking of the polymer chains and elimination of oxidation through the manufacturing process. The introduction of femoral material alternatives further reduces the prospect of surface wear in knee and hip components. All lead to the promise of articulation longevity. Cost, as well as patient selection, and the unknown clinical realities of long-term series reporting are concerns about these options that only time will elucidate. This symposium deals with the hopes, promises and caveats that these emerging materials offer in the treatment of the arthroplasty patient.