Have newer bearing surfaces changed expectations regarding the longevity of total hip arthroplasty?

Bone Joint J. 2020 Jul;102-B(7_Supple_B):105-111. doi: 10.1302/0301-620X.102B7.BJJ-2019-1545.R1.


Aims: The purpose of this study is to examine six types of bearing surfaces implanted at a single institution over three decades to determine whether the reasons for revision vary among the groups and how long it takes to identify differences in survival.

Methods: We considered six cohorts that included a total of 1,707 primary hips done between 1982 and 2010. These included 223 conventional polyethylene sterilized with γ irradiation in air (CPE-GA), 114 conventional polyethylene sterilized with gas plasma (CPE-GP), 116 crosslinked polyethylene (XLPE), 1,083 metal-on-metal (MOM), 90 ceramic-on-ceramic (COC), and 81 surface arthroplasties (SAs). With the exception of the COC, all other groups used cobalt-chromium (CoCr) femoral heads. The mean follow-up was 10 (0.008 to 35) years. Descriptive statistics with revisions per 100 component years (re/100 yr) and survival analysis with revision for any reason as the endpoint were used to compare bearing surfaces.

Results: XLPE liners demonstrated a lower cumulative incidence of revision at 15 years compared to the CPE-GA and CPE-GP groups owing to the absence of wear-related revisions (4% for XLPE vs 18%, p = 0.02, and 15%, p = 0.003, respectively). Revisions for adverse local tissue reactions occurred exclusively among the MOM (0.8 re/100 year) and SA groups (0.1 re/100 year). The revision rate for instability was lower among hips with 36 mm and larger head sizes compared to smaller head sizes (0.2% vs 2%, p < 0.001).

Conclusion: The introduction of XLPE has eliminated wear-related revisions through 15-year follow-up compared to CPE-GP and CPE-GA. Dislocation incidence has been reduced with the introduction of larger diameter heads but remains a persistent concern. The potential for adverse local tissue reactions with MOM requires continued follow-up. Cite this article: Bone Joint J 2020;102-B(7 Supple B):105-111.

Keywords: ceramic; crosslinked polyethylene; extensively porous-coated cylindrical stems; hemispheric cementless cup; metal-on-metal; outcome; revision; total hip arthroplasty.

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Hip / instrumentation*
  • Ceramics
  • Chromium Alloys
  • Cohort Studies
  • Follow-Up Studies
  • Hip Prosthesis*
  • Humans
  • Joint Instability / surgery
  • Male
  • Metal-on-Metal Joint Prostheses
  • Middle Aged
  • Polyethylene
  • Prosthesis Design*
  • Prosthesis Failure / trends*
  • Reoperation / statistics & numerical data
  • Virginia


  • Chromium Alloys
  • Polyethylene