PubMed2002
Large inter-patient variability in wear rate and wear direction have been a ubiquitous attribute of total hip arthroplasty (THA) cohorts. Since patients at the high end of the wear spectrum are of particular concern for osteolysis and loosening, it is important to understand why some individuals experience wear at a rate far in excess of their cohort average. An established computational model of polyethylene wear was used to test the hypothesis that, other factors being equal, clinically typical variability in regions of localized femoral head roughening could account for much of the variability observed clinically in both wear magnitude and wear direction. The model implemented the Archard abrasive/adhesive wear relationship, which incorporates contact stress, sliding distance, and (implicitly) bearing surface tribology. Systematic trials were conducted to explore the influences of head roughening severity, roughened area size, and roughened area location. The results showed that, given the postulated wear factor elevations, head roughening variability (conservatively) typical of retrieval specimens led to approximately a 30 degrees variation in wear direction, and approximately a 7-fold variation in volumetric wear rate. Since these data show that randomness in head scratching can account for otherwise-difficult-to-explain variations in wear direction and wear rate, third-body debris may be a key factor causing excessive wear in the most problematic subset of the THA population.