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How prevalent are implant wear and osteolysis, and how has the scope of osteolysis changed since 2000?

Dr. Marshall is Assistant Professor, University of Texas Health Science Center, San Antonio, TX. Dr. Ries is Professor and Vice Chairman, University of California–San Francisco Medical Center, San Francisco, CA. Dr. Paprosky is Associate Professor, Rush Medical College, Rush University Medical Center, Chicago, IL.

*The Implant Wear Symposium 2007 Clinical Work Group included John J. Callaghan, MD, John M. Cuckler, MD, Jorge O. Galante, MD, DMSc, Alejandro González Della Valle, MD, Stuart B. Goodman, MD, PhD, James I. Huddleston, MD, Lynne C. Jones, PhD, David G. Lewallen, MD, Henrik Malchau, MD, PhD, William Maloney, MD, Amanda Marshall, MD, Wayne Paprosky, MD, Hollis G. Potter, MD, Michael D. Ries, MD, Aaron Rosenberg, MD, Thomas P. Sculco, MD, Bernard N. Stulberg, MD, Audrey K. Tsao, MD, and Timothy Wright, PhD.

Dr. Marshall or a member of her immediate family has received research support from DePuy. Dr. Ries or a member of his immediate family has received royalties from Smith & Nephew. Dr. Paprosky or a member of his immediate family has received royalties from Zimmer.

Although the incidence of failures resulting from wear-related osteolysis and associated severe bone defects are expected to diminish with important advances in polyethylene manufacturing and processing, alternative bearing surfaces, implant design, and revision techniques, current failures still reflect concerns regarding earlier ultra-high–molecular-weight polyethylene sterilization and degradation. Clinical experience before the year 2000 included rates of wear and osteolysis from 10% to as high as 70% at 7- to 14-year follow-up. With recent advances, early clinical results are encouraging, demonstrating 50% to 81% decreases in radiographic wear rates. These improvements should eventually reduce the burden of future revision hip and knee surgery. However, the long-term in vivo durability of total hip arthroplasties using these alternative materials and bearing couples has not yet been well established, and considerably fewer clinical data are available for other types of joint arthroplasties, such as total knee arthroplasty.