Radiographic evaluation of linear wear of bipolar hemiarthroplasty devices .

BACKGROUND

The indications for bipolar hemiarthroplasty (BHA) have been narrowing as those for total hip arthroplasty (THA) have been expanding in cases of femoral neck fracture and initial stages of osteonecrosis of femoral head (ONFH). It is difficult to measure wear after BHA because the equipment used has a dual bearing system with an inner head inside a metal outer cup. The present study aimed to (1) use a roentgenograph to measure linear wear after BHA with different acetabular conditions around the bipolar cup, and (2) compare the linear wear of polyethylene between integral bipolar cup (IBC) and Centrax prostheses.

METHODS

From among patients who had undergone BHA in our department after 1996, we analyzed 48 joints with osteoarthritis (OA) and without acetabular cartilage, as well as 25 joints with ONFH of stage 3 or less, in which the acetabular cartilage remains. Two types of bipolar cup prostheses were used: the IBC, which was gamma-sterilized in air using 2-Mrad irradiation, and the Centrax, which was gamma-sterilized in nitrogen using 3-Mrad irradiation. To image the inner head , we used high-pressure X-ray photography; we measured linear wear of the polyethylene with software using Martell Method 1.

RESULTS

Comparing mean annual linear wear between the OA and ONFH groups, using IBC prostheses in both groups, there was a significant difference (0.213 mm vs. 0.096 mm, respectively;  = ). There was a significant difference between the Centrax and IBC prostheses in OA patients in terms of linear wear (0.04 mm vs. 0.213 mm;  = 0.0181).

CONCLUSION

The linear wear of polyethylene in BHA implants can be affected by the material used to manufacture the bipolar cup. Such implants should only be used for appropriate indications.