Role of polyethylene oxidation and consolidation defects in cup performance

Quality factors such as particle consolidation and oxidation have been claimed to impair the performance of ultrahigh molecular weight polyethylene implants, but no definite data estimate their real effect. To assess the influence of these quality determinants in wear, wear rate, and time in service at a single, well proven design, the percentage area of polyethylene sections occupied by nonconsolidated polyethylene particles, the presence of a white band, and the amount of polyethylene oxidation (through density curves) were evaluated in 92 retrieved Charnley acetabular components with available clinical data. The average percentage area of nonconsolidated polyethylene particles in cup sections was 3.1%. There were 11 cups showing a subsurface white band. The authors observed an average density in the deep polyethylene of 0.9420 g/cc after an average in vivo use of 9.8 years (range, 0.08-20.3 years). Banded cups showed significantly higher subsurface densities. When studying the relationship among clinical and material factors with performance variables, wear measurements (obtained through radiographic methods and direct measurements of polyethylene thickness in the collected implants) correlated with age at implantation, activity, and time in service. Weight was a determinant of the wear rate. None of the studied polyethylene quality factors showed a definite association with wear performance or time to failure in this series. Implant survivorship was not significantly impaired in the 22.225-mm Charnley low friction replacement by a subsurface white band or by a higher area occupied by nonconsolidated particles. Fewer nonconsolidated particles were not associated with longer survivorship. This design proved tolerance to polyethylene quality variations, in the signaled ranges, without a significant effect in the system performance.