Alternative Bearing Surfaces: Crosslinked Polyethylenes for Total Hip Replacement. A Review

Highly crosslinked polyethylene has three major advantages as an alternative bearing surface that are in common with ceramic on ceramic and metal on metal. They are 1) prior long-term in vivo human use, 2) low wear and lysis rates and 3) being a relatively inert material. In addition they have several other advantages not shared by the hard on hard alternatives. They include lower cost, less difficulty from impingement and less difficulty with accelerated wear if the acetabular component is placed in a high degree of abduction. It does not have the brittleness of ceramic nor the metallosis that can accompany the metal on metal bearings. Polyethylene is familiar, without a learning curve. It is more adaptable, with extended lip liners, offset liners and constrained liners. For certain of the crosslinked polyethylenes wear is independent of head diameter. Thus, there appear to be several valuable advantages for considering highly crosslinked polyethylene as the preferred alternative bearing.