Distinguishing wear and creep in clinically retrieved polyethylene inserts

There is an increasing awareness of the clinical problems associated with ultra-high-molecular-weight polyethylene (UHMWPE) wear and failure in orthopedics. To better understand the reasons for wear and failure, methods were developed using polarized light microscopic analysis and backscattered electron (BSE) imaging with correlated elemental analysis to distinguish the contributions of wear, creep, and third-body particulate. This study determined that microscopic metal particles (< 10 microns) previously not observed with the stereomicroscope could be easily observed with the BSE technique. BSE imaging identified embedded metal in 5/5 of the tibial and 2/4 of the acetabular inserts, which were thought to be free of metal debris after stereoscopic examination. Correlated elemental analysis showed that the microscopic particles could be traced to the elements known to be present in the porous coatings of the retrieved uncemented implants. Creep was distinguished from wear in the total hip and total knee inserts by using polarized light microscopic techniques. Continued development of polarized light microscopic techniques applied in this investigation should assist biomaterials experts in the future to better distinguish wear and creep in retrieved clinical inserts. The correlated BSE and elemental analysis will assist in determining the roll of microscopic third-body particular in wear and osteolysis in total joint replacement.