In the laboratory environment, through the accumulation of experiments over the past 10 years, we obtained the wear experimental data shown in Fig. 1. The data shows that the volume wear can be reduced by about 95% by changing the liner material from PE to XLPE while the ball material remains unchanged (data changes from left to right in the quadrangle of Fig. 1). Changing the liner material from metal (stainless steel and cobalt-chromium-molybdenum) to ceramic reduces the volumetric wear by 20-32% (from bottom to top in the quadrangle in Fig. 1), while keeping the liner material the same. Thus, in vitro experimental data show that the reduction in volumetric wear by replacing the PE liner with an XLPE liner is much greater than the reduction in volumetric wear by replacing the metal ball head with a ceramic ball head.
The data above are in vitro experimental data. People are more interested in in vivo clinical statistics. By searching the information of clinical studies on hip wear in the last 5 years (2017-2021) [1] to [58], the data shown in the table below were obtained:
Analyze and discuss:
- Both XLPE and ceramic ball heads began to be used in large numbers around the year 2000. The closer to the present, the further away from 2000, and the longer the follow-up, the higher the value of the clinical data. Here the results of studies from 2007-2021 were chosen to represent the most recent results to date.
- Metal ball heads counted in clinical studies include cobalt chromium molybdenum ball heads and stainless steel ball heads. Ceramic ball heads include BIOLOX forte and BIOLOX delta ball heads. xlpe includes xlpe with and without added vitamin E, and also includes xlpe with different irradiation measures from various companies. ball head mean diameter, radial linear wear, and volumetric wear are all counted using weighted averages.
- The number of clinical cases of metal and ceramic ball heads on regular PE was 339 and 216, respectively, which was much smaller than the number of clinical cases of both on XLPE, which was 2,696 and 1,761, respectively (shown in Fig. 2). The clinical follow-up times of the metal ball head and ceramic ball head for ordinary PE were 12.2 and 9.2 years, respectively, both of which were greater than the clinical follow-up times of the two for XLPE, which were 8.2 and 6.5 years, respectively (as shown in Figure 3).
Figure 2 Distribution of surgical cases
Figure 3 Distribution of follow-up time
- The linear wear of the metal and ceramic ball heads on normal PE was 0.0900mm and 0.0751mm respectively (as shown in Figure 4). The wear of both on XLPE was 0.0363mm and 0.0342mm. a reduction of 60% and 55%, respectively. Replacing the mating of ordinary PE and XLPE against metal ball joints with mating against ceramic ball joints reduces wear by 16% and 6%, respectively, which is much smaller than the 55% to 60% reduction above. This indicates that the reduction in linear wear caused by replacing PE with XLPE is significantly greater than the change caused by replacing the metal ball head with the ceramic ball head.
Fig. 4 Linear wear distribution
- The volumetric wear of the metal and ceramic ball heads on regular PE is 38.89mm³ and 48.55mm³, respectively (as shown in Figure 5). The volumetric wear of both on XLPE was 27.92mm³ and 28.34mm³. This is a reduction of 28% and 42%, respectively. Replacing the mating of normal PE and XLPE against metal ball head with mating against ceramic ball head, the volumetric wear not only did not decrease, but both increased.
Fig. 5 Volumetric wear distribution
6. A possible explanation for the above phenomenon is that the diameter of the ceramic ballheads used in vivo clinically is larger than the diameter of the metal ballheads (as shown in figure 6).
Fig. 6 Ball Diameter Distribution
Volume wear can be expressed as the following equation:
△V=πR²△R
where ∆V is the volumetric wear, R is the radius of the ball head, and ∆R is the radial linear wear. This formula indicates that volumetric wear is proportional to linear wear and proportional to the square of the diameter of the ball head. That is, the effect of the diameter of the ball head on volumetric wear is greater than the effect of radial linear wear (as shown in Figure 7).
Fig. 7 Relation between volumetric wear and radial wear
7. The average diameter of the metal ball end is 27mm for PE and 35.4mm for XLPE, an increase of 8.4mm, and the volumetric wear is still reduced from 38.89mm³ to 27.92mm³. This indicates that the reduction in volumetric wear due to the substitution of PE by XLPE not only cancels out the increase in wear due to the increase in diameter, but there is also an abundance of it, which is generally shown as a reduction in volumetric wear. The average diameter of metal ball head to PE is 27mm, and the average diameter of ceramic ball head to PE is 29.3mm, which is only increased by 2.3mm, but leads to the increase of volumetric wear from 38.89mm³ to 48.55mm³. This indicates that the contribution of the ceramic ball head to reduce wear by replacing the metal ball head is very small and is not enough to offset the increase in wear caused by even a slight increase in the diameter of the ball head.
Conclusion:
In summary, the data from both the test in the lab and the clinical evaluation shows that the reduction of the wear contributed by XLPE is much more than by Ceramic heads in both linear and volumatric wear of total hip replacement.
bibliography:
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