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Rim Damage in Retrieved 1st and 2nd Generation Annealed Highly Crosslinked Polyethylene Hip Liners
Journal article   Open access   Peer reviewed

Rim Damage in Retrieved 1st and 2nd Generation Annealed Highly Crosslinked Polyethylene Hip Liners

Daniel W MacDonald, Tabitha Derr, Gregg R Klein, Arthur L. Malkani, Michael A. Mont and Steven M Kurtz
The journal of arthroplasty, v 41(3), pp 953-957
Mar 2026
DOI: https://doi.org/10.1016/j.arth.2025.07.021
Featured in Collection :   Research Supported by Drexel Libraries' OA Programs
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https://doi.org/10.1016/j.arth.2025.07.021View
Published, Version of Record (VoR) Open Access via Drexel Libraries Read and Publish Program 2025 Open CC BY V4.0

Abstract

INTRODUCTION Highly crosslinked polyethylene (HXLPE) was clinically introduced in total hip arthroplasty (THA) with the goal of reducing wear and wear debris-induced osteolysis. Studies have shown increased wear performance of the HXLPE articulating surface as compared to controls. However, wear particles can also be produced via different mechanisms, particularly at the rim of the HXLPE liner. The purpose of this study was to compare the rim damage of 1st-generation-annealed and 2nd-generation sequentially annealed HXLPE THA acetabular liners. METHODS There were 89 annealed and sequentially annealed THA liners implanted for five or more years that were collected at routine revision THA surgery. The liners were revised predominantly for loosening, infection, and instability. The single-dose annealed liners were implanted for a longer duration than the sequentially annealed liners (mean difference of 2.5 years, P < 0.001). The liners were inspected for the seven damage mechanisms. In addition, we noted instances of subsurface whitening. The extent of damage was described as the arc angle of the rim that exhibited each damage mode. RESULTS Rim damage was observed on 46% of annealed liners and 25% of sequentially annealed liners. Delamination, subsurface whitening, burnishing, and abrasion were the damage mechanisms observed in both cohorts. The extent of delamination and subsurface whitening was greater in the annealed HXLPE liners than in the sequentially annealed HXLPE liners. We did not observe any correlation between the extent of any damage mechanism and implantation time, head size, rim oxidation, or implant design (P > 0.05). DISCUSSION We analyzed the rim damage mechanisms of retrieved 1st - and 2nd-generation-annealed HXLPE THA liners. We observed that the sequentially annealed liners had lower levels of damage as compared to annealed HXLPE liners. The clinical relevance of these findings is unclear at this point, as the biological response to HXLPE particles is multifactorial.

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