Femoral-Acetabular Mating: The Effect of Femoral and Combined Anteversion on Cross-Linked Polyethylene Wear

Cross-linked polyethylene (XLPE) has generally low rates of wear and osteolysis at 10 years, but component position may become important with longer follow-up. At 5-13 years, neither acetabular component lateral opening angle nor version were significantly correlated to wear. In the present study, we analyzed the effects of femoral anteversion and combined anteversion on XLPE wear.

Forty-two well-functioning primary total hip arthroplasties in 36 patients, performed by a single surgeon via a posterior approach, were followed for a minimum of 5 years (mean, 7.1 years; range, 5.0-10.3). All hips had a modular, XLPE liner with a ≥36-mm bearing. Femoral anteversion was measured on the modified Budin view. Wear was measured on radiographs using a validated, computer-assisted, edge-detection-based algorithm. The mean lateral opening angle was 40.4° (range, 22.6°-50.3°). The mean acetabular version was 19.1° (range, 11.3°-27.5°). Neither of these variables was significantly correlated to wear. Effects of femoral anteversion and combined anteversion on XLPE wear were assessed using linear and polynomial regression analysis.

Femoral anteversion (mean, 18.4°; range, 6.8°-30.7°) was significantly correlated to linear wear (mean, 0.06 mm/y; range, 0-0.16), showing an inverse parabolic relationship with the least wear occurring at 18.2° (P = .02). Combined anteversion (mean, 37.2°; range, 21.8°-54.3°) showed a similar significant relationship with the least wear at 38.1° (P < .001). Based on regression, combined anteversion between 24.6° and 50.4° resulted in linear wear rates less than 0.1 mm/y.

To the authors' knowledge, this is the first study to identify femoral anteversion as an independent factor influencing XLPE wear, with least wear occurring around 18°. At 5-10 years, average linear wear of XLPE is below 0.1 mm/y over a 25°-50° range of combined anteversion, with the least wear around 38°. Femoral-acetabular mating is a product of both components. Femoral component version and combined anteversion had a greater effect on wear than acetabular component lateral opening angle. Additional studies are warranted, but these results indicate that the sensitivity of wear studies is increased with version assessments.