Is there evidence for accelerated polyethylene wear in uncemented compared to cemented acetabular components? A systematic review of the literature

Abstract

Joint arthroplasty registries show an increased rate of aseptic loosening in uncemented acetabular components as compared to cemented acetabular components. Since loosening is associated with particulate wear debris, we postulated that uncemented acetabular components demonstrate a higher polyethylene wear rate than cemented acetabular components in total hip arthroplasty. We performed a systematic review of the peer-reviewed literature, comparing the wear rate in uncemented and cemented acetabular components in total hip arthroplasty. Studies were identified using MEDLINE (PubMed), EMBASE and the Cochrane Central Register of Controlled Trials. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The search resulted in 425 papers. After excluding duplicates and selection based on title and abstracts, nine studies were found eligible for further analysis: two randomised controlled trials, and seven observational studies. One randomised controlled trial found a higher polyethylene wear rate in uncemented acetabular components, while the other found no differences. Three out of seven observational studies showed a higher polyethylene wear in uncemented acetabular component fixation; the other four studies did not show any differences in wear rates. The available evidence suggests that a higher annual wear rate may be encountered in uncemented acetabular components as compared to cemented components.

Validation of a computer‐assisted method for measurement of radiographic wear in total hip arthroplasty using all polyethylene cemented acetabular components

“…In addition, there is increasing recent evidence that cemented fixation of acetabular components might be more reliable than that of cementless components beyond the first postoperative decade . This phenomenon could be related to accelerated PE wear in uncemented compared to cemented acetabular components …”

“…3,4 This phenomenon could be related to accelerated PE wear in uncemented compared to cemented acetabular components. 5 As polyethylene wear remains a major factor in failure of THA through particle-induced osteolysis and resultant aseptic loosening, 6 new challenges for in vivo measurement of wear in THA implants are a matter of major concern. Indeed, wear measurement is critical to adequately evaluate new materials and can also help to decide when to monitor patients more closely and when to consider revision surgery.…”

To cement or not to cement acetabular cups in total hip arthroplasty: a systematic review and re-evaluation

“…The described higher wear rates after cementless fixation of the acetabulum [27, 28] are also suggested in this study, but are based on two unmatched cohorts and do not reach a level of significance. It is therefore difficult to draw hard conclusions based on these data.…”

Excessive polyethylene wear and acetabular bone defects from standard use of a hooded acetabular insert in total hip arthroplasty

“…3), it cannot be ignored that PE wear was also present from the eccentric position of the femoral head in the cup and thus from the articulating bearing. The experienced annual wear rate of the articulating PE of 0.24 mm (0.00-1.17) is still relatively high and higher than one would expect for the Sulene PE (ultrahigh-molecular-weight polyethylene) used in this insert [15]. It is possible that the leverage of the femoral component on the hooded rim caused forces and peak stresses also on the articulating insert resulting in accelerated wear patterns.…”