Analysis of the Risk of Wear on Cemented and Uncemented Polyethylene Liners According to Different Variables in Hip Arthroplasty

Abstract

Wear debris in total hip arthroplasty is one of the main causes of loosening and failure, and the optimal acetabular fixation for primary total hip arthroplasty is still controversial because there is no significant difference between cemented and uncemented types for long-term clinical and functional outcome. To assess and predict, from a theoretical viewpoint, the risk of wear with two types of polyethylene liners, cemented and uncemented, a simulation using the finite element (FE) method was carried out. The risk of wear was analyzed according to different variables: the polyethylene acetabular component’s position with respect to the center of rotation of the hip; the thickness of the polyethylene insert; the material of the femoral head; and the relationship of the cervical–diaphyseal morphology of the proximal end of the femur to the restoration of the femoral offset. In all 72 simulations studied, a difference was observed in favour of a cemented solution with respect to the risk of wear. With regard to the other variables, the acetabular fixation, the thickness of the polyethylene, and the acetabular component positioning were statistically significant. The highest values for the risk of wear corresponded to a smaller thickness (5.3 mm), and super-lateral positioning at 25 mm reached the highest value of the von Mises stress. According to our results, for the reconstruction of the acetabular side, a cemented insert with a thickness of at least 5 mm should be used at the center of rotation.