One hundred and twenty-nine Charnley acetabular components were acquired at the time of revision surgery and a tribological investigation undertaken. The relative occurrence of pitting in the unworn and worn regions of the sockets suggest that most of the cement ingress occurs during the early part of the service life. The penetration depth of the explanted sockets was determined using the shadowgraph technique. Observation of the profiles in the wear planes suggest that, in general, the creep component was not a significant proportion of the overall change in the inner bore of the socket. Using weighted ordinary least squares regression, in which the intercept was not assumed to be zero, mean penetration and wear volume rates of 0.02 (SE = 0.02) mm/year and 55 (SE = 5) mm3/year, respectively, were recorded and are in agreement with other retrieval studies. In neither case was the intercept found to be significantly different from zero. A mean clinical wear factor, Kclinical, equal to 2.1 (SE = 0.2) x 10(-6) mm3/N m was calculated which is considerably larger than that found in laboratory experiments which purport to reflect in vivo conditions. In this analysis, a significant positive intercept was observed [96 (SE = 36) mm3] and may be evidence of the small initial penetration due to creep reported in simulator experiments. A strong positive association between kclinical and the arithmetical mean roughness, Ra, of the femoral head was also demonstrated although the rate of change was not as great as that cited for laboratory experiments.

We report the findings from independent prospective clinical and laboratory-based joint-simulator studies of the performance of ceramic femoral heads of 22.225 mm diameter in cross-linked polyethylene (XLP) acetabular cups. We found remarkable qualitative and quantitative agreement between the clinical and simulator results for the wear characteristics with time, and confirmed that ceramic femoral heads penetrate the XLP cups at only about half the rate of otherwise comparable metal heads.In the clinical study, 19 hips in 17 patients were followed for an average of 77 months. In the hip-joint simulator a similar prosthesis was tested for 7.3 million cycles.Both clinical and simulator results showed relatively high rates of penetration over the first 18 months or 1.5 million cycles, followed by a very much lower wear thereafter. Once an initial bedding-in of 0.2 mm to 0.4 mm had taken place the subsequent rates of penetration were very small. The initial clinical wear during bedding-in averaged 0.29 mm/year; subsequent progression was an order of magnitude lower at about 0.022 mm/year, lower than the 0.07 mm/year in metal-to-UHMWP Charnley LFAs.Our results show the excellent tribological features of alumina-ceramic-to-XLP implants, and also confirm the value of well-designed joint simulators for the evaluation of total joint replacements.

No abstract

Between November 1962 and December 1990 a group of 1092 patients, 668 women and 424 men, under the age of 51 years at the time of surgery, underwent 1434 primary Charnley low-frictional torque arthroplasties and are being followed up indefinitely. Their mean age at operation was 41 years (12 to 51). At the latest review in June 2001 the mean follow-up had been for 15 years 1 month. Of the 1092 patients 54 (66 hips) could not be traced, 124 (169 hips) were known to have died and 220 (248 hips) had had a revision procedure. At a mean follow-up of 17 years and 5 months, 759 patients (951 hips) are still attending. In this group satisfaction with the outcome is 96.2%. The incidence of deep infection for the whole group was 1.67%. It was more common in patients who had had previous surgery (hemi- and total hip arthroplasties excluded), 2.2% compared with 1.5% in those who had not had previous surgery, but this difference was not statistically significant (p = 0.4). There were fewer cases of deep infection if gentamicin-containing cement was used, 0.9% compared with 1.9% in those with plain acrylic cement, but this was not also statistically significant (p = 0.4). There was a significantly higher rate of revision in patients who had had previous hip surgery, 24.8% compared with 14.1% in those who had not had previous surgery (p < 0.001). At the latest review, 1.95% are known to have had at least one dislocation and 0.4% have had a revision for dislocation. The indication for revision was aseptic loosening of the cup (11.7%), aseptic loosening of the stem (4.9%), a fractured stem (1.7%), deep infection (1.5%) and dislocation (0.4%). With revision for any indication as the endpoint the survivorship was 93.7% (92.3 to 95.0) at ten years, 84.7% (82.4 to 87.1) at 15 years, 74.3% (70.5 to 78.0) at 20 years and 55.3% (45.5 to 65.0) at 27 years, when 55 hips remained 'at risk'.

No abstract