Wear of Historical Polyethylenes in Hip Prostheses. Biomechanical Success and a Biological Failure

Polyethylene wear debris induced osteolysis is a major cause of failure in artificial hip joints. Sub micrometre size particles are taken up by macrophages which are stimulated to release osteolytic cytokines such as TNFα. This leads to bone resorption, loosening and failure. In vitro cell culture studies have shown particles in the size range 0.1 to 1 micrometre to be at least six times more reactive than larger particles. Studies of historically used gamma irradiated in air polyethylene show increased wear rate with damaged femoral heads and with aged and oxidised polyethylene. The aged and oxidised polyethylene also produced a greater percentage of smaller particles leading to increased osteolytic potential. Combined tribological and biological simulation models have been developed for pre-clinical assessment of osteolytic potential of artificial hip joints.