Factory-Assembled Polyethylene Linings in Metal Backing Show Higher Wear Rates Compared to Equisized All-Polyethylene Sockets

Two series of cementless total hip arthroplasty with acetabular sockets of a threaded truncated cone design were compared regarding volumetric wear rates. The first series included all-polyethylene acetabular sockets of the type Endler (E-PE); in the second series, a nonmodular titanium metal-backed polyethylene (E-MB) socket with an identical outer shape to E-PE was implanted. Bearings were articulated with alumina 32-mm diameter ball heads. Ninety-five retrieved devices were examined with a modified fluid displacement method using dental self-polymerizing precision casts. The sockets had to be revised mainly because of wear-induced osteolysis: E-PE after 10.6 years on average and E-MB after 7.8 years (P = .002). Comparison with unused sockets showed mean wear rates of 63 mm³/y for E-PE and 120 mm³/y for E-MB (P = .0008). Increased contact stress and load deformation due to reduction of polyethylene thickness in E-MB compared to E-PE were identified as predominant reasons for higher wear rates.