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How have alternative bearings (such as metal-on-metal, highly cross-linked polyethylene, and ceramic-on-ceramic) affected the prevention and treatment of osteolysis?

Dr. Callaghan is the Lawrence and Marilyn Dorr Chair in Hip Reconstruction and Research, Professor of Orthopaedics, Rehabilitation and Biomedical Engineering, University of Iowa, and Staff Orthopaedic Surgeon, Veterans Affairs Medical Center, Iowa City, IA. Dr. Cuckler is Orthopaedic Surgeon, Alabama Spine and Joint Center, PC, Birmingham, AL. Dr. Huddleston is Assistant Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA. Dr. Galante is The Grainger Director, Rush Arthritis and Orthopedic Institute, Rush-Presbyterian-St. Luke’s Medical Center, and Professor of Orthopedic Surgery, Department of Orthopedic Surgery, 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. Sculpco, MD, Bernard N. Stulberg, MD, Audrey K. Tsao, MD, and Timothy Wright, PhD.

Dr. Callaghan or a member of his immediate family has received research or institutional support, miscellaneous nonincome support, commercially derived honoraria, or other nonreseach-related funding and royalties from DePuy. Dr. Cuckler or a member of his immediate family has received royalties and miscellaneous nonincome support, commercially derived honoraria, or other nonreseach-related funding from Biomet and is a consultant for Biomet. Dr. Galante or a member of his immediate family has received research or institutional support and royalties from Zimmer. Neither Dr. Huddleston nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Osteolysis is a multifactorial process dependent on surgical technique, implant design, patient factors, and material composition. Alternative bearing surfaces, such as highly cross-linked polyethylene, ceramic-on-ceramic, and metal-on-metal articular surfaces, have been introduced in an attempt to reduce wear and osteolysis following total hip arthroplasty. Intermediate-term follow-up data available suggest that the prevalence and severity of osteolysis may be reduced with these materials compared with conventional metal-on-polyethylene bearing surface couples. However, long-term data are presently unavailable; the future performance of these bearings awaits clinical validation.