Radiographic Evaluation of Penetration by the Femoral Head into the Polyethylene Liner over Time*

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We examined the pattern of temporal penetration by thirty-two-millimeter-diameter femoral heads into polyethylene liners in a group of 105 hips (103 patients) in which an Arthropor metal-backed cup had been implanted. Each patient was evaluated radiographically and clinically at a minimum of four different postoperative intervals. The initial evaluation was performed a mean of 2.9 weeks (range, one to fifteen weeks) postoperatively, and the latest evaluation was performed a mean of 7.9 years (range, five to ten years) postoperatively. Two-dimensional wear-that is, penetration by the femoral head into the ultra-high molecular weight polyethylene liner-was determined from anteroposterior radiographs of the pelvis with a computer analysis system that calculated the change in the position of the center of the head relative to the center of the cup.Three new findings are reported. First, there was a large difference (mean, 1.1 millimeters) between the center of the head and that of the cup as measured on the initial postoperative radiographs. This difference underscores the need for researchers to consider the initial displacement of the head when measuring and reporting polyethylene wear.Second, although there was wide variation in responses among individuals, temporal examination of the data revealed a trend toward a decreasing rate of penetration with time. Moreover, the rate of penetration appeared to reach a steady-state value after the sixth postoperative year and remained nearly constant until the ninth postoperative year.Third, by comparing the subsets of patients who had the greatest and the least initial penetration by the head, we found that penetration behavior, although remarkably different between the groups in the first three years postoperatively, became similar with time.Clinical RelevanceWhen making decisions regarding individual patients or hip systems that demonstrate penetration by the femoral head into the polyethylene liner, clinicians should consider the patterns of penetration over time. Measurements of the amount and rate of penetration that are based solely on the most recent radiograph do not represent the full clinical picture. We advocate more frequent radiographic follow-up and, when available, analysis of serial radiographs for patients who have excessive penetration by the femoral head into the acetabular liner.

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