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Hard-on-soft bearings

Hard-on-soft bearings have included metal on PE articulations and more recently ceramic on PE. The metal on PE bearing has been the most common bearing surface combined with good long term results especially in lower demand individuals. It' s advantage is that it is inexpensive due to it s low cost and ease of manufacture; it is technically easier to implant; it allows immediate load-bearing; surgeons have wide experience with this method; and present-day acetabula made of cross-l inked polyethylene will bring better future results than seen with older types o f polyethylene (Harkess JW. et al., 2008). Titanium heads have been least favourable due to high rates of volumetric wear, notch sensitivity and third body wear and is no longer used for head manufacture (Agins HJ. Et al., 1988). Cobalt-chrome on PE bearings have had reasonable long-term success (Wright TM. 1 991). The problems of degradation of mechanical properties of PE and increased wear rates due to previous gamma irradiation in air and oxidation on the shelf have now partially been overcome by enhanced cross linking and stabilization pro cedures that include exposing it to a sequence of radiation in an inert environm ent combined with an annealing or melting procedure (Archibeck MJ. Et al., 2001) . PE now has excellent wear properties due to processing to achieve enhanced cross links producing ultra-high molecular weight PE (UHMWPE). This has led to improve d surface hardness and enhanced resistance to adhesive and abrasive wear, albeit at the expense of increased brittleness and susceptibility to fracture. The use of vitamin E and other additives can potentially improve mechanical properties of PE. Despite this, metal-on-PE bearings still have the highest wear rates when compared to other combinations at 0.28mm/year of volumetric wear (Harkess JW. 2 003). Using ceramic heads which have better scratch resistance than metal heads in the se bearings have led to more favourable wear rates of less than 150 m per year. Th is constitutes a 50% decrease in wear rates reported for traditional metal-on-PE bearings (Schmalzried TP. et al., 1999). Using the Trent regional arthroplasty register, the survival rate was analyzed a t ten years of 1198 consecutive Charnley total hip replacements carried out acr oss a single health region of the United Kingdom in 1990. At ten years, informat ion regarding outcome was available for 1001 hips (83.6%). The recipients of 62 Charnley THRs (6.2%) had documented revision surgery. In 23, both components had been revised, in nine only the acetabular component, in 13 only the femoral com ponent, in 12 an excision arthroplasty had been performed and in five the outcom e was unknown. Aseptic loosening (3.3%) was the most common indication for revis ion followed by infection and recurrent dislocation (Allami KM. et al., 2006). Kim et al. (2005) reviewed the long-term results of 110 conventional cementless porous-coated anatomic total hip prosthesis (100 pt) for an average 19.4 year. O verall, 23 (21%) acetabular components were revised after a mean of 10.6 years ( 6 to 20). Twenty-one, well-fixed components were removed because of extensive pe riprosthetic osteolysis and two because of loosening and osteolysis. Overall, 10 femoral components were revised for aseptic loosening after a mean of 9.8 years (5 to 20). Four femoral components (4%) were revised for loosening and osteolys is, four undersized stems (4%) for aseptic loosening alone and two for recurrent dislocation (Kim Y H. 2005).