Wear and Osteolysis in Total Hip Arthroplasty

Particulate debris-induced osteolysis resulting from in vivo wear of the articular bearing surfaces is recognized as a major factor limiting the longevity of total hip arthroplasty (THA). The mechanism of bearing surface wear particle generation is multifactorial, with millions of wear particles of varying size, shape, and composition being generated with use over time by a single bearing couple. Particulate wear debris has been shown to be associated with a locally aggressive biological response that can lead to periprosthetic bone loss and aseptic loosening of the implants. Furthermore, recent epidemiological and retrieval studies have led to concerns regarding the systemic dissemination of prosthetic wear debris, including effects due to end-organ retention and potential carcinogenesis. Improvement in the long-term success of THA will depend in part on the ability to develop alternative bearing couples that will minimize wear debris and the subsequent local and systemic effects.