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All Hip Replacement Patients Should Receive Metal-on-Polyethylene Bearings

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OrthopaedicsOne Poll: Highly cross-linked polyethylene bearings should be the implant of choice for young and active hip replacement patients

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Our colleagues from the Université de Montréal and the University of Toronto present an important and quite à propos debate on the clinical usage and indications of hard-on-hard bearings versus the routine use of highly cross-linked polyethylene.

As it occurs commonly in orthopaedics, we tend to push new designs as the solution to all of our previous difficulties and challenges. For bearing surfaces, this is especially the case when we consider issues such as osteolysis, dislocation, and minimizing the morbidity of revision hip surgery.

A perfect example is the monoblock acetabular components with a metal-on-metal bearing,1 which were initially designed for hip resurfacing, but that are now used for primary total hip replacement to minimize the risk of dislocation. Recent ion data2 and clinical data, however, are showing higher ion levels and a higher incidence of adverse tissue reactions3 with this construct, compared with a modular acetabular shell with a metal-on-metal bearing and 28- and 36-mm femoral head, which conversely have been shown to be a reliable construct at mid-term follow-up.4,5 The same can be said with highly cross-linked polyethylene, in which wear rates with 28- and 32-mm heads have shown excellent results.6,7 But to also address the problem of instability, 36- and 40-mm heads are commonly used in young active patients, and early in vivo data are showing higher wear rates.8

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Viewpoint 1: Prasad Antapur, MRCS, FRCS (Tr&Orth); Rajiv Gandhi, MD, FRCSC; Nizar Mahomed, MD, ScD, FRCSC

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The Case for MOP Bearings for All THA Patients

Viewpoint 2: Sanket Diwanji, MS (Ortho); Pascal-André Vendittoli MD, MSc, FRCSC

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The Case Against MOP Bearings for All THA Patients

 

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Viewpoint:Poll - All Hip Replacement Patients Should Receive Metal-on-Polyethylene Bearings