Volumetric Wear of Highly Cross-Linked Polyethylene Sockets in Total Hip Arthroplasty Differs Among Brands: A Retrieval Study

Abstract

Outcomes after total hip arthroplasty (THA) remain limited by wear and wear particle reaction. Although highly cross-linked polyethylene (HXLPE) mitigated this issue, there are major differences among the various brands available. This study quantified, for the first time, the volumetric wear on the retrievals from various HXLPE brands, using an optical coordinate measuring machine. Patient- and implant-related factors and component orientation were considered. As of 30.06.2025, 104 HXLPE sockets were available, and 79 could be analysed, excluding those too severely deformed/damaged. The median (range) time in situ was 8.7 (2.1–22.1) years. Wear volume and volumetric wear rate were 91 (1–674) mm3 and 9 (0–130) mm3/year, respectively. Highcross (n = 56, Medacta) experienced approximately five times more wear (p < 0.001) than Durasul (n = 17, Zimmer Biomet). The other brands (n = 6) were too small in group size at this stage for statistical analysis. The correlation (R2 = 0.94) between linear and volumetric wear was excellent, but high wearing retrievals had a strong impact on this analysis, whereas low wear retrievals showed high variability. Differences in wear were mostly driven by the brand, while other parameters had only a minor impact. This is the first retrieval study comparing volumetric wear among various brands of retrieved HXLPE bearings. Not all HXLPE bearings should be considered equal. As the cohort grows, further parameters and brands may be integrated.