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Wear Performance of Materials Used in Artificial Hip Joints
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Abstract:
Following the 1956 introduction of polytetrafluoroethylene (PTFE) total hip replacements (THR), a concerning question was how much wear debris could periarticular tissues tolerate before onset of adverse reactions. John Charnley’s historical studies demonstrated that wear in PTFE (“Teflon”) bearings led to destructive hip lesions within 3 years. While smaller femoral heads somewhat reduced wear, Teflon debris remained intolerable. In 1962 Charnley’s laboratory identified polyethylene (UHMWPE) as a substantially more wear-resistant polymer, launching the Charnley low-friction arthroplasty (LFA) in 1962. Three important results were clear: 1) femoral head diameter is the major wear determinant, i.e. the Charnley Diameter-Wear effect (“CDW”), 2) laboratory studies demonstrated UHMWPE had superior wear resistance to PTFE, and 3) major differences existed between laboratory predictions and clinical wear data, a phenomenon we shall term Laboratory Wear Divergence (“LWD”). This review examines wear data published by four laboratories to evaluate reproducibility, accuracy, and relevance of historical wear studies (1956-1976). Charnley’s wear laboratory described Teflon:UHMWPE wear ratios ranging 200:1 to 500:1 (1969). The introduction of UCLA’s wear machine in 1978 provided a dramatic improvement in experimental procedures. Using gravimetric weight-loss measurements in bovine-serum lubricated studies, the UCLA method for 316SS:UHMWPE samples achieved a wear precision of 0.2 mm3/Mc (±15%). Despite this precision, the LWD wear ratio (1600:1) for PTFE:UHMWPE wear greatly exceeded Charnley’s clinical (16:1) and laboratory (200:1) ratios. Orthopedic Hospital of Los Angeles (OHLA) reported (1981) a simulator design that incorporated multi-directional motion using crossing-path wear (CPW) motion. The pilot PTFE study (28 mm THR) yielded exceptionally high wear (2100 mm3/Mc), representing a debris release of 180 mm3 per 24-hours and prompted termination of study. This PTFE simulator wear overshot the clinical 28 mm Teflon wear (1171 mm3/year), a ratio of 1.8:1. This PTFE:Teflon wear (laboratory vs clinical) will be designated “WRP”. Kinamed (1996) investigated the Charnley-diameter-wear effect (CDW) using Al2O3: UHMWPE THR (22.25, 26, 28 mm dia.). Assuming Charnley’s clinical report is typical of LFA (60 mm3/year), the UHMWPE simulator ratio PCR = 0.6:1, i.e. it undershot the clinical UHMWPE datum. The 32.8 mm3/Mc wear rate (28 mm THR) corresponded to a CDW ratio of
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