LINEAR AND VOLUMETRIC WEAR OF DOUBLE MOBILITY IMPLANTS

Abstract

Purpose of the study: The double-mobility concept was introduced for clinical applications for total hip arthroplasty in 1976. The concept preserves joint range of motion while increasing stability. In this study we evaluated the consequences of these advantages in terms of polyethylene wear, measuring wear both on the concave and convex surfaces and volumetrically.

Material and methods: Forty polyethylene inserts were explanted and analyzed. Explantation had been performed for mechanical or septic failure after eight years implantation on average. Mean age of patients at implantation was 46 years. After examining the gross aspect of the insert, surface analysis was performed with direct measurement of changes in the curvature using a BHN 706 position sensor for the inner concave surface and lateral projection for the outer convex surface. Estimated measurement error was ±5μm for each method; the manufacturer's tolerance for production of the inserts was 50μm. Volumetric wear was determined by reference to the manufacturer’s data. Student’s t test for paired series was applied.

Results: At gross inspection, all inserts had lost the strips originally present on the convex surface; 40% presented visible wear of the retaining ring. Mean annual wear (± standard deviation, SD) obtained with the measuring system was 9±9 μm/yr) for the convex surface and 73 ± 69 μm/yr for the concave surface. Total annual wear, the sum of inner and outer surface wear, was 82±72 μm/yr. The mean volumetric wear was 28±28 mm3/year for the convex surface and 25±23 mm3/year for the concave surface and 53.4±40 mm3/year for total wear.

Discussion: Total wear for these 40 double-mobility inserts which had functioned in vivo was not greater than the values reported for the metal-polyethylene bearing with 22.2 mm femoral heads. The double mobility is not associated with greater wear. While there was no significant difference between the wear volume of the convex versus the concave surfaces, the differentials wear were widespread, which can be considered to result from functional differences.