Fracture of a Cross-Linked Polyethylene Liner

Blumenfeld, Thomas J.; McKellop, Harry A.; Schmalzried, Thomas P.; Billi, Fabrizio

doi:10.1016/j.arth.2010.07.009

Cited by 54 publications

(29 citation statements)

References 17 publications

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“…242−245,507 For this reason, cross-linked UHMWPE has become commonly used, although its excessive hardness and easy breakability are problematic. 508−512 Having favorable characteristics that are absent in conventional materials, that is, high wear resistance and low breakability, MWCNT-conjugated UHMWPE is suitable as a sliding parts material for artificial joints (Figure 12). On the other hand, ceramics are also used in the sliding parts of artificial joints.…”

Section: Discussion and Perspectivementioning

confidence: 99%

Safe Clinical Use of Carbon Nanotubes as Innovative Biomaterials

et al. 2014

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Section: Discussion and Perspectivementioning

confidence: 99%

Safe Clinical Use of Carbon Nanotubes as Innovative Biomaterials

et al. 2014

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“…67 However, concerns regarding the potential for mechanical failures and fractures with thinner polyethylene liners remain as sporadic cases have been reported. 68,69 …”

Section: Large Diameter Headsmentioning

confidence: 99%

Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA

Guyen

2016

EFORT Open Reviews

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Dislocation remains a common cause of failure after total hip arthroplasty. The limitations of existing approaches to address instability have led to the development of powerfull options: constrained liners, dual mobility and large heads. These implant-related options have proven to be very efficient, but have raised concerns.With constrained liners, restricted range of motion (ROM) is responsible for impingement leading to high likelihood of failure, depending on the design, with various failure modes.Improvements of the bearing materials have addressed some of the concerns about increased volumetric wear of conventional polyethylene and offer an option to reduce instability: large diameter heads have the advantage of increased ROM before impingement, increased head-neck ratio, and jump distance. Highly cross-linked polyethylene helps address the risk for increased wear, and also large heads provide improved stability without the risk of mechanical failures observed with constrained liners. However, the increase of the head size remains limited as reducing the thickness of the liner may lead to fractures. In addition, the jump distance decreases as the cup abduction increases.The dual mobility concept simultaneously attempts to address head-neck ratio, constraint, and jump distance. Despite the need for longer follow-up, concerns raised about potential increased wear and intra-prosthetic dislocation with first generation implants have been addressed with modern designs.With a dramatic increase of the head-neck ratio whilst reducing the risk of mechanical failure or excessive wear, dual mobility THA outperforms large diameter heads and constrained liners at 10 years follow-up. For these reasons, dual mobility continues to gain interest worldwide and is becoming the most popular option to manage instability.Cite this article: Guyen O. Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA. EFORT Open Rev 2016;1:197-204. DOI: 10.1302/2058-5241.1.000054.

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“…The introduction of improved bearing surfaces including highly cross-linking of polyethylene has reduced this risk. Liners used alongside larger femoral heads are thinner, and therefore there is an increased risk in liner fracture over time; small numbers of these have been reported [10]. Another concerning issue is the increased risk of corrosion at the taper-femoral head junction with subsequent release of debris into the periprosthetic soft tissues, causing inflammatory reactions and pain [8,11].…”

Section: Introductionmentioning

confidence: 97%