Journal of Orthopaedic Surgery 2001, 9(2): 71–76
Qualitative analysis of polyethylene wear in
a bipolar femoral prosthesis: A case report
Nobuhiro Kaku, Hiroshi Tsumura and Takehiko Torisu
Department of Orthopaedeic Surgery, Oita Medical University, Oita, Japan
ABSTRACT
We researched the qualitative changes in the
polyethylene of a bipolar head retrieved at revision
occurring in vivo using optical microscopy and Fourier
transform infrared spectroscopy. The bearing surface
of the outer head was smooth with no definable
scratches delamination. However, the evidence of
delamination of the beveled throat region and cracking
at the base of the leaf was noticed. The degree of
oxidation was different in each area of the polyethylene
in the bearing component and that of the rim was
shown to be higher than that of the bearing surface.
Comparing the rate of ketone and ester, ketone binding
was frequently found around the prosthetic rim rather
that at the bearing surface. However, the ratio of ester
at the surface was higher than that at the deep area of
the same rim. We considered these results showed local
environmental effects in vivo play a significant role in
dictating the response.
Key words: bipolar hip arthroplasty, polyethylene, wear debris,
oxidation, Fourier transform infrared spectroscopy
Address correspondence and reprint requests to: Dr Nobuhiro Kaku, Department of Orthopaedeic Surgery, Oita Medical
University, Hasama-machi, Oita 879–5593, Japan. E-mail: nobuhiro@oita-med.ac.jp
INTRODUCTION
Wear and the generation of ultra high molecular weight
polyethylene (UHMWPE) wear particles is now
considered the most important cause of long term
failure in total hip arthroplasty. 1,2,10–13,16 Micron-size
polyethylene wear particles enter the tissues
surrounding the joint, causing adverse cellular
reactions which lead to osteolysis and loosening 18,24.
To limit the generation of wear debris, implants should
have a low coefficient of friction and a resistance to
third-body wear damage of the bearing surface.6,14–17
Also, the cellular reactions to the wear debris should
be minimised.
Since Bateman, in a 1974 study, described the use
of the bipolar femoral head prosthesis in osteoarthritis
of the hip,3 some clinical results have been reported as
favorable.4,21 Messieh et al., however, described wear
debris originating from the contact of the bipolar head
with the femoral neck in 1994,22 and subsequently other
reports have described acetabular osteolysis following
bipolar hip arthroplasty.7,19 Polyethylene wear and
subsequent osteolysis have also been recognized as
severe problems in bipolar hip arthroplasty.
The purpose of this paper is to investigate
qualitative changes in polyethylene in vivo using an
72 Nobuhiro Kaku et al. Journal of Orthopaedic Surgery

outer head that was retrieved at revision. We reported the IR spectrum between 1749–1691cm–1 and PE is the
a case of a female patient in whom the polyethylene C-C rocking band 739–708 cm–1 (Graph 1).
component failed following bipolar hip arthroplasty
with acetabular reaming. This patient had marked
acetabular osteolysis; however, neither osteolysis nor RESULTS
any radiolucent lines were apparent around the
femoral stem. The roentgenograms showed that the outer head had
moved medially, appearing similar to the protrusio
acetabli of rheumatoid arthritis. The extent of the clear
MATERIALS AND METHODS zone around the outer head widened gradually from
12 years after the primary operation and finally
This case involved a female patient who was 49 years reached a maximum of 5 mm. However, as there was
old at the time of the primary operation. She had no osteolysis or any clear zone around the stem, we
suffered from dysplasic hip osteoarthritis which was only replaced the bipolar outer head with allo-bone
treated with primary arthroplasty with the reaming grafting of the acetabular defect (Fig.1).
of the acetabulum and implantation of a bipolar hip
arthroplasty with an Aufranc-Turner cemented stem
with a 22.225 mm inner femoral head. When this
patient returned to the clinic with hip pain 15 years
after the primary operation, osteolysis around the outer
head was recognized. When the patient was 64 years
old, revision was performed and the outer head was
retrieved. Therefore, we have been able to follow this
patient for fifteen years following the primary
operation.
In order to research the qualitative changes in the
polyethylene occuring in vivo, we investigated the
shape, location and volume of the polyethylene wear
in the retrieved outer head. The wear analysis was
performed on this component to determine wear rate
penetration in millimeters per year. This calculation
was made utilizing mathematical calculations of
polyethylene thickness. The size of it was identified,
manufacturing blueprints were matched up to
determine the original polyethylene thickness at the
pole region, and the outer head was measured in the
same region to define the thickness difference. This
difference between the original and actual thickness
was used in conjunction with the implantation age of
the component to calculate the wear rate. Also, optical
microscopy and Fourier transform infrared (FT-IR)
spectroscopy was used to assess the oxidation of the
polyethylene. Thin sections approximately 0.025 mm
thick were cut with a microtome, parallel to the radial
direction, through the leaflets and bearing surface. The
sections were placed on a microscope slide with a cover
slip glued over the section in order to keep them flat.
The sections were then examined with transmitted
plane and polarized light microscopy. The same 0.025
mm sections used for the optical microscopy were used Figure 1 Case. The patient was female and her age at revision
to measure the IR spectra by transmission, placing the was 64 years, followed up for 15 years. The clear zone around
the outer head on the roentgenograms widened gradually
sections on a KBr plate on a Nicolet-Plan FT-IR twelve years later postoperatively and the outer head moved
microscope. The degree of oxidation was measured as to the supero-medial direction, so she felt hip pain at the same
the ratio C=O:PE, where C=O represents the area under time.
Vol. 9 No. 2, December 2001 Qualitative analysis of polyethylene wear in a bipolar femoral prosthesis
The outer head diameter was 44 mm. The bearing
surface of the outer head was smooth, polished and
glistening with no definable scratches or delamination
(Fig. 2). The average diameter of the bearing socket
was 22.771 mm (normal diameter 22.377 mm). Average
diameter of the ‘throat’ was 20.015mm (normal
value19.380 mm). The wear on the bearing surface was
0.197 mm. This represented an annual linear wear rate
of 0.0131 mm.
Figure 2 Visual findings of bearing surface was smooth and
glistening with no definable scratches.
Visible discoloration of the beveled polyethylene
rim was apparent in places. Evidence of delamination
of the beveled throat region and cracking at the base
of the leaf was noticed. Very little abrasive wear
occurred on the beveled surface of the leaflet (Fig. 3).
Figure 3 Evidence of delamination in the beveled region and
a crack were visible at the base of the leaf. No evidence for
excessive wear of the beveled region prior to the delamination
damage.
73
Features such as a black band could not be seen in
the main socket load-bearing region with an optical
microscopy using reflected light (Fig. 4). With
transmitted light, this black band was visible
approximately 0.70 mm below the surface in many
regions of the polyethylene component, but not
uniformly over the section. This is equivalent to the
white band seen under reflected light microscopy (Fig.
5). These optical effects were caused by micro fractures
produced in the brittle, highly crystalline regions. Some
leaflets exhibited variable degrees of recrystallization
as determined by a black subsurface band, with
relatively little on the inner surface but severe in the
area of the delamination on the beveled surface. In the
beveled region under polarized light, the development
of the recrystallization within the resin grains was
clearly apparent.
Figure 4 There was no visible evidence such as a black band
in the main socket bearing region in optical microscopy and
reflected light.
Figure 5 With transmitted light, a black band was visible
approximately 0.70 mm below the surface in many regions,
but not uniformly over the section. This was equivalent to the
white band seen under reflected light.
74 Nobuhiro Kaku et al. Journal of Orthopaedic Surgery

Table 1 presents the FT-IR spectroscopy data. The DISCUSSION

degree of oxidation was different in each area of the
polyethylene-bearing component. The degree of
oxidation of the rim was shown to be higher than that
of the bearing surface (Fig. 6) (Table1). Comparing the
ratio of ketone and ester, the ketone binding was
frequently found around the prosthetic rim rather than
at the bearing surface. However, the ratio of ester at
the surface was higher than that at the deep area of
the same rim. The distribution of the radiation-induced
oxidation is of interest. In this case almost no oxidation
was detectable in the lower region of the insert. All of
the regions, which appeared clear, exhibit an oxidation
ratio of between 0.18 and 0.28. The main crystallization
changes occurred at the resin boundaries, as illustrated
by the darkened boundaries. The area below the clear
surface layer, i.e. rom 0.70 to 1.40 mm, had a maximum
oxidation ratio of 0.33–0.41 and is where the
delamination may occur.
Figure 6 The number shows the area of the polyethylene
insert.
The mean annual wear rate with the 22 mm inner head
in total hip arthroplasty (THA) was reported by
Charnley and Halley in 1975 to be 0.09 mm, 8 while
Wrobleski found this to be 0.096 mm in 1993.26 In 1998,
Ingemar et al. studied wear and migration rates in a
series of 102 hip replacements randomised to have
either a cemented polyethylene Charnley socket or a
porous uncemented Harris-Galante type–1 cup using
radiostereometric analysis.15 The mean annual wear
rate was found to be 0.09 mm in the Charnley sockets
and 0.1 mm in the Harris-Galante socket. Chun-Hsiung
measured linear polyethylene wear in uncemented
Osteonics components using digital and special
software of their own design in 1998.9 The mean annual
wear was 0.15 mm, which increased to 0.23 mm in hips
showing evidence of osteolysis.
For bipolar prosthesis, Bose et al. reported a case
that had osteolysis of the acetabulum and in which
the mean annual wear rate of the retrieved outer head
was 0.17 mm.5 Using radiographs showing the inner
articulation of the bipolar hip prosthesis, Kusada and
Kuroki also reported an 0.17 mm wear rate, and that
there was no difference between the annual wear rate
of hips with and without osteolysis.20 In this case, the
mean annual wear rate of the bearing socket was 0.0131
mm. We think the wear results here are quite low.
However, this result cannot be compared directly with
other reports which used roentgenograms to assess
liner wear rates and the mechanical-stress was not
usually of uneven distributions in bipolar hip
arthroplasy unlike THA. We found smooth surfaces
within the socket region of this outer head which
differed from the roughness often found in the
acetabular cups of THA.25 We think that one reason is
the reduction of friction with the dual bearing design.
Another reason is the relative absence of third body

Table 1
The C=O rate of place numbers 4,5,6 was higher than that of other place numbers
and ketone band rate of numbers 5 and 6 was higher than other places

Area C=O PE C=O/PE Keton/Ester

1 0.288 11.148 0.03 ND

2 1.858 10.124 0.18 0.5
3 3.159 11.273 0.28 0.7
4 2.437 13.337 0.18 4.3
5 5.228 12.808 0.41 3.1
6 4.187 12.658 0.33 1.3
Vol. 9 No. 2, December 2001 Qualitative analysis of polyethylene wear in a bipolar femoral prosthesis
wear of the bearing surfaces due to the locking system
between the inner head and the bearing insert, as well
as the narrow entrance in a bipolar hip prosthesis.
Additionally, the insert wear in the socket region
occurred in a surface region where there was minimum
oxidation and no excessive recrysyallization, where
0.70 mm of clear region remained. So the amount of
wear was minor and the bearing surface looked
polished, so no direct relationship was found between
the wear in the inner articulation and occurrence of
osteolysis in this study.
In bipolar hip prosthesis, not only the bearing
surface, but also the polyethylene rim may produce
wear debris. Some investigators have reported that a
large amount of debris was due to severe rim abrasion
by neck-cup contact and that this seemed to cause
osteolysis.23 In addition, we found discoloration and
extensive delamination occurred in the beveled region
on some leaflets. The excessive crystallization that
occurred approximately 0.70 mm below the insert
surface, we think, was responsible for the delamination
on some of the leaflets with the infusion of fluid and
resultant discoloration. This was the result of
recrystallization in the resin, which was able to take
place by the increased chain mobility resulting from
the radiation-induced oxidation.
The degree of oxidation was different within each
area in a polyethylene insert, and that of the rim, which
had been in contact with joint fluid, was shown to be
higher than that of bearing surfaces. It was our
understanding that the degree of oxidation at the point
of femoral neck contact was higher than the other areas
around the rim.
It is possible that supersonic waves are generated
in the joint fluid with the regular fluctuations of
pressure that occur with load bearing and movement.
With this in mind, cavitation, where many small
bubbles break out in the fluid during the decreasing
the pressure phase would be generated. 27 These
bubbles expand with decreasing pressure and when
their diameter reaches more than about 0.1 mm, they
are crushed on the next increasing pressure phase. This
phenomenon is called ‘cavitation collapse’ and the heat
(about a few thousands degree Centigrade) increases
locally at that time. The effect of heat makes a situation
where oxidation occurs more easily at the same place
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CONCLUSION
Considering that the radiation during sterilization was
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the variation in the degree of radiation induced
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local environmental effects play a significant role in
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polyethylene chain segments due to joint fluid effects
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ACKNOWLEDGEMENTS
The authors wish to thank Dr Donald F Gibbons,
Corporate Scientist, 3M Biosciences Laboratory, for his
technical support and advice.
76 Nobuhiro Kaku et al. Journal of Orthopaedic Surgery

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