Deformation of the acetabular polyethylene liner and the backside gap

Polyethylene wear of acetabular components may cause osteolysis and aseptic loosening in total hip arthroplasty. Case reports of wear between the polyethylene liner and acetabular metal backing (backside wear) have promoted speculation on the clinical importance of debris generation at this site and the potential importance of insert conformity. We examined 90 retrieved nonconforming acetabular components from a single manufacturer. Twenty-four liners (27%) showed polyethylene deformation corresponding to screw holes on the backside surface. The location of screw-hole deformations corresponded to the direction of polyethylene deformation (wear) on the articular surface in all cases. The polyethylene liners with backside deformations were significantly thinner than the liners without deformation (P = .02). The presence of acetabular osteolysis did not significantly correlate with backside deformation, but there was a significant association between osteolysis and wear of the articular surface (P = .0004). In this implant design, backside deformation (wear) may not be due to micromotion at the interface but to the viscoelastic nature of ultra-high-molecular weight polyethylene.