Bearing surface wear and osteolysis are major factors limiting the durability of total hip arthroplasty (THA). Second generation annealed highly cross-linked polyethylene (HXLPE) and ceramics were introduced to THA for their excellent wear rates. However, there is little data comparing the wear rates of metal and ceramic heads on second generation HXLPE.
Sixty patients who received a noncemented THA with a 32- or 36-mm delta ceramic head were matched with 60 THAs with a 32- or 36-mm metal head based on gender, head size, follow-up, and University of California, Los Angeles activity score. Linear and volumetric wear rates were measured.
At mean 6-year follow-up, the mean linear wear rates were 0.012 mm/y (standard deviation [SD] 0.045; 95% confidence interval [CI] 0.001-0.024) and 0.018 mm/y (SD 0.025; 95% CI 0.012-0.025) for the ceramic and metal groups, respectively (P = .724). The mean volumetric wear rates for the ceramic and metal head groups were 11.9 (SD 43.0; 95% CI 0.7-23.0) and 17.3 (SD 23.9; 95% CI 11.1-23.4), respectively. No significant differences were detectable in either the mean linear or volumetric wear rates (P = .380 and P = .398, respectively).
Second generation HXLPE had low wear rates and we were unable to detect a significant difference in wear rates with 32- or 36-mm metal and ceramic heads. We believe that this is due to the excellent tribological properties of second generation HXLPE. We continue to use ceramic as standard of care because of issues of trunnionosis with metal heads.