Highly cross-linked polyethylene acetabular liners retrieved four to five years after revision surgery: A report of two cases

There is currently considerable interest in the use of highly cross-linked polyethylene (XLPE) acetabular liners for total hip arthroplasty (THA). In literature, only a single retrieval analysis of one type of XLPE liner implanted for greater than four years exists. The purpose of the present report is to quantify surface deviations in two XLPE liners implanted during revision THA and retrieved between four to five years after implantation. The two XLPE acetabular liners (Reflection, Smith and Nephew Inc., Memphis, TN) were retrieved from patients undergoing their second revision surgery, at 4.90 and 4.07 years. The retrieved liners and a new, non-implanted, unworn liner of the same size were scanned using micro-computed tomography (micro-CT). Articular surface deviation maps were created by comparing the retrievals to the unworn liner, based on the liner geometry obtained from micro-CT. The linear penetration rates were found to be 0.018 and 0.008 mm/year. Localized scratches and pits with deviations greater than 0.205 mm were also found on the articular surfaces of both liners. The XLPE liners retrieved from the two cases demonstrated low linear penetration rates. Regions with greater focal deviations were also apparent, likely due to third-body wear. The results are consistent with previously published clinical follow-ups of other XLPE liners.