Articulating choices in total hip arthroplasty: Why’s, wherefores, and caveats

Over the last several decades, our understanding of total hip arthroplasty (THA) tribology (friction, lubrication, wear, and the design of bearings) has evolved tremendously. Overall, THA implants and bearing surfaces are improving and with current generation highly cross-linked polyethylene (HXLPE), it is expected that the longevity of THA will be unprecedented. Bearings surface usage varies significantly by region, but today the North American market is heavily dominated by cobalt chrome or ceramic on HXLPE. There has also been a dramatic decline in the number of metal-on-metal THAs being used due to the large (and growing) number of controversies surrounding these implants. Nevertheless, as trends in THA bearing surfaces change, one thing will always remain constant: meticulous surgical technique is critical to the success and durability of these implants.