Abstract
Intentionally crosslinked polyethylene has improved the survivorship of total hip replacement and is the current standard bearing material for total hip arthroplasty. Regardless of the manufacturing method and counter-surface, the wear rates have been reduced on the order of 90% compared to historical materials, with a substantial reduction in the occurrence of osteolysis. Squeaking is not an issue. The wear of crosslinked polyethylene bearings has not shown the position sensitivity of hard-on-hard bearings. Liner fracture and dissociation have been reported, most commonly in association with malposition, and their occurrence has been decreased by improved modularity. Further, the consequences of a fractured polymeric bearing are substantially less than those of a fractured ceramic bearing. In most markets, there is a cost-differential favoring crosslinked polyethylene. A clinical advantage of ceramic-ceramic must be demonstrated, not theorised, before declaring it to be the new standard.
