Scott D L, Campbell P A, McClung C D, Schmalzried T P
Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, California 90007, USA.
J Arthroplasty. 2000 Jan;15(1):35-46. doi: 10.1016/s0883-5403(00)91103-3.
There have been several reports of osteolysis associated with rapid wear of Hylamer. A detailed analysis of retrieved implants and tissues can identify factors contributing to rapid wear and osteolysis. The mean linear wear rate of 12 liners was 0.49 mm/y, and 11 of 12 hips had progressive retroacetabular osteolysis. The average patient age was 50 years, and the mean implantation time was 50 months. All liners were sterilized by gamma irradiation in air. There was an 11-month difference in the average shelf-life of the 3 liners that were white and those that were darker in color. The volumetric wear rate of the white liners was 30% less than that of the others, suggesting a difference in the wear resistance of the liners as a function of shelf life. The mean average surface roughness (Ra) and the mean maximum surface roughness (R(max)) of the femoral heads were increased 3-fold and 50-fold compared with typical values for unused femoral heads. Evidence of 3-body wear, such as metal particles embedded in the liners, was commonly present. The pattern of backside liner deformation and burnishing was consistent with relative motion between the liner and the shell. In addition to generating Hylamer wear particles, repetitive axial motion between the liner and shell could generate fluid pressure, which transmitted through holes in the acetabular shell could cause or contribute to the development of retroacetabular osteolysis. Hylamer particles of variable shape and size, consistent with generation by several wear modes, were isolated from periprosthetic tissues.
已有多篇关于与Hylamer快速磨损相关的骨溶解的报道。对取出的植入物和组织进行详细分析可以确定导致快速磨损和骨溶解的因素。12个衬垫的平均线性磨损率为0.49毫米/年，12个髋关节中有11个出现了髋臼后缘进行性骨溶解。患者平均年龄为50岁，平均植入时间为50个月。所有衬垫均在空气中进行伽马射线灭菌。白色的3个衬垫与颜色较深的衬垫的平均保质期相差11个月。白色衬垫的体积磨损率比其他衬垫低30%，这表明衬垫的耐磨性随保质期而有所不同。与未使用的股骨头的典型值相比，股骨头的平均表面粗糙度（Ra）和平均最大表面粗糙度（R(max)）增加了3倍和50倍。常见有三体磨损的证据，如嵌入衬垫中的金属颗粒。衬垫背面的变形和抛光模式与衬垫和髋臼杯之间的相对运动一致。除了产生Hylamer磨损颗粒外，衬垫和髋臼杯之间的反复轴向运动会产生流体压力，该压力通过髋臼杯上的孔传递，可能会导致或促进髋臼后缘骨溶解的发展。从假体周围组织中分离出了形状和大小各异的Hylamer颗粒，这与多种磨损模式产生的颗粒一致。
