Comparison of alumina-polyethylene and metal-polyethylene in clinical trials

The dimensional changes of hip sockets of Müller-type total endoprostheses is the subject of this article. Regular anteroposterior roentgenographs of the pelvis were taken to determine the orientation of the center of the prosthetic head in relation to the wire marker of the polyethylene cup. Three different materials used for the femoral balls and matched with polyethylene as socket material were investigated, and the results of the displacement of the ball into the socket were compared. Both creep and wear contribute to the dimensional changes of the hip sockets; the proportional amount of each mechanism is not known. Data from laboratory examinations suggest a relatively high rate of creep in the first six months after implantation. With longer periods, the dimensional changes are predominately caused by wear. In the beginning of joint function, measurements show a high rate of the yearly dimensional changes. The head shifts up to 0.5 mm per year and diminishes after five years to rates of 0.1-0.2 mm, respectively. All dimensional changes that exceed a shift of the head of 0.2 mm per year are considered to be unfavorable and to contribute to loosening of the implants. Using metallic balls (Protasul-2), 64% had a wear rate of less than 0.2 mm; of those using Prostasul-10, 77% had lower rates than 0.2 mm. In patients where ceramic balls were implanted, the displacement rate was below 0.2 mm per year in 95%. Therefore, ceramic seems to be the most favorable material.