Higher offset cross-linked polyethylene acetabular liners: is wear a significant clinical concern?

Introduction: Total hip arthroplasty (THA) is the 2nd most common total joint replacement surgery in the United States. However, not all THA devices perform well and need revised for several reasons including dislocation. Higher offset acetabular liners reduce this problem by creating a more anatomically/biomechanically natural hip joint, increasing soft-tissue tension, and accommodating larger femoral heads in smaller acetabular cups via increased polyethylene thickness. To our knowledge, however, in vivo wear (another failure mode) performance of offset acetabular liners remains unknown. Methods: 2 cohorts of 40 individuals (0-mm, 4-mm offset acetabular liners, respectively) from a single surgeon’s consecutive caseload were assessed. 6-week/5-year post-op radiographs were compared using a validated method using SolidWorks software to assess in vivo linear and volumetric wear rates. Resultant surgical offset was also quantified using this method. Results: Linear wear rate for 0-mm and 4-mm offset cohorts were 0.01 ± 0.09 mm/year and 0.08 ± 0.12 mm/year, respectively. Volumetric wear rate for 0-mm and 4-mm offset cohorts were 30.4 ± 20.4 mm³/year and 61.6 ± 42.1 mm³/year, respectively. Both of these were statistically significant. Neither linear nor volumetric wear rate was correlated with resultant surgical offset. Discussion: To our knowledge, this is the 1st study to compare in vivo wear performance of 0-mm and 4-mm offset acetabular liners. Although linear and volumetric wear rates were different between cohorts, neither reached previously established osteolysis thresholds. Moreover, wear rates were not correlated with resultant surgical offset. Finally, no patients in either cohort showed signs of osteolysis nor needed revision. As such, the clinical relevance of the wear rate differences is potentially less significant.