Bearing surfaces in primary total hip arthroplasty

Abstract

Total hip arthroplasty (THA) is widely considered one of the most successful surgical procedures in orthopaedics. It is associated with high satisfaction rates and significant improvements in quality of life following surgery. On the other hand, the main cause of late revision is osteolysis and wear, often a result of failure of bearing surfaces.Currently, several options are available to the surgeon when choosing the bearing surface in THA (ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoPE), metal-on-polyethylene (MoPE)), each with advantages and drawbacks.Very few studies have directly compared the various combinations of bearings at long-term follow-up. Randomized controlled trials show similar short- to mid-term survivorship among the best performing bearing surfaces (CoC, CoXLPE and MoXLPE). Selection of the bearing surface is often 'experience-based' rather than 'evidence-based'.The aim of this paper is therefore to evaluate the main advantages and drawbacks of various types of tribology in THA, while providing practical suggestions for the surgeon on the most suitable bearing surface option for each patient. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180300.

Keywords: bearings; ceramic; hip; metal-on-metal; polyethylene; total hip arthroplasty; tribology.

Fig. 1

Intra-operative measurement of acetabular components and liner of a total hip arthroplasty: a) the metal back has a minimum thickness that must be taken into account; b) a minimum polyethylene (PE) thickness must be preserved even when selecting large diameter femoral heads; c) ceramic liners can be thinner than PE liners.