Review Article: Polyethylene wear and osteolysis in total hip arthroplasty

Polyethylene wear has been accepted as a major cause of osteolysis in total hip arthroplasty. Submicron particles, which are secondary to abrasive wear, migrate into the effective joint space and stimulate a foreign-body response resulting in bone loss which is mainly mediated by macrophages. Diagnosis depends on serial radiographic evaluation and frequent follow-up. Polyethylene wear and osteolysis can be prevented by reducing the wear such as using a small femoral head, adaptive polyethylene thickness, suitable surgical techniques, non-polyethylene articulation, etc. The presence of cement or circumferential coatings may also retard the distal migration of particles. Medicines such as NSAIDs and bisphosphonate appear to inhibit the progress of osteolysis. As far as treatment, revision surgery is able to reconstruct the joint by replacing partial or total prosthesis and repair the defect by bone grafting according to intraoperative assessment.