Cyclic compressive loading results in fatigue cracks in ultra high molecular weight polyethylene

Updates on Biomaterials Used in Total Hip Arthroplasty (THA)

One of the most popular and effective orthopedic surgical interventions for treating a variety of hip diseases is total hip arthroplasty. Despite being a radical procedure that involves replacing bone and cartilaginous surfaces with biomaterials, it produces excellent outcomes that significantly increase the patient's quality of life. Patient factors and surgical technique, as well as biomaterials, play a role in prosthetic survival, with aseptic loosening (one of the most common causes of total hip arthroplasty failure) being linked to the quality of biomaterials utilized. Over the years, various biomaterials have been developed to limit the amount of wear particles generated over time by friction between the prosthetic head (metal alloys or ceramic) and the insert fixed in the acetabular component (polyethylene or ceramic). An ideal biomaterial must be biocompatible, have a low coefficient of friction, be corrosion resistant, and have great mechanical power. Comprehensive knowledge regarding what causes hip arthroplasty failure, as well as improvements in biomaterial quality and surgical technique, will influence the survivability of the prosthetic implant. The purpose of this article was to assess the benefits and drawbacks of various biomaterial and friction couples used in total hip arthroplasties by reviewing the scientific literature published over the last 10 years.

Ultra-High-Molecular-Weight-Polyethylene (UHMWPE) as a Promising Polymer Material for Biomedical Applications: A Concise Review

Ultra-High Molecular Weight Polyethylene (UHMWPE) is used in biomedical applications due to its high wear-resistance, ductility, and biocompatibility. A great deal of research in recent decades has focused on further improving its mechanical and tribological performances in order to provide durable implants in patients. Several methods, including irradiation, surface modifications, and reinforcements have been employed to improve the tribological and mechanical performance of UHMWPE. The effect of these modifications on tribological and mechanical performance was discussed in this review.

Mechanical characteristics of medical grade UHMWPE under dynamic compression

The mechanical properties of medical grade ultrahigh molecular weight polyethylene (UHMWPE) are critical for the safety and integrity of UHMWPE implantation. Accordingly, the mechanical features of UHMWPE are tested under repeated stress-controlled and strain-controlled compression at room temperature. Some important effect factors, such as stress rate, mean stress, stress amplitude, strain rate, mean strain, strain range and multiple load steps are further considered in detail. Results indicate that the lower stress rate causes the greater accumulated plastic strain and the accumulated plastic strain rate becomes increasingly lower with increasing number of cycles. The strain range and accumulated plastic strain rate decrease rapidly in the first stage, and then become almost steady during the second stage. Especially, the accumulated plastic strain rate per cycle for each case is less than 0.01 %/cycle after the initial 100 cycles. This means that the plastic strain accumulates very slowly and the shakedown behavior always occurs. Moreover, obvious cyclic softening and stress relaxation behaviors can be observed under cyclic strain-controlled compression during the first 50 cycles. This indicates that the accumulated plastic stain in the initial 100 cycles and the cyclic stress relaxation during the first 50 cycles should be assessed for the functionality of UHMWPE implantation.

Fatigue toughness of irradiated vitamin E/UHMWPE blends

Radiation cross-linked ultrahigh molecular weight polyethylenes (UHMWPEs) have become the standard-of-care in total joint replacements (TJR) in the last decade because of their superior wear resistance in comparison with previously used "conventional" gamma sterilized UHMWPE. Some first generation radiation cross-linked UHMWPEs were stabilized against oxidation by post-irradiation melting, which significantly reduced their fatigue crack propagation resistance or fatigue toughness. Second generation cross-linked UHMWPEs incorporated instead an antioxidant such as vitamin E, eliminating the need for melting. In this study, we investigated the fatigue crack propagation resistance and the impact toughness of vitamin E-blended and radiation cross-linked UHMWPEs as a function of vitamin E concentration and radiation dose. Both properties were strongly dependent on the cross-link density and they showed a good correlation with each other (R(2)  = 0.89). © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1514-1520, 2016.

Application of viscoelastic fracture model and non-uniform crack initiation at clinically relevant notches in crosslinked UHMWPE

The mechanism of crack initiation from a clinically relevant notch is not well-understood for crosslinked ultra high molecular weight polyethylene (UHMWPE) used in total joint replacement components. Static mode driving forces, rather than the cyclic mode conditions typically associated with fatigue processes, have been shown to drive crack propagation in this material. Thus, in this study, crack initiation in a notched specimen under a static load was investigated. A video microscope was used to monitor the notch surface of the specimen and crack initiation time was measured from the video by identifying the onset of crack initiation at the notch. Crack initiation was considered using a viscoelastic fracture theory. It was found that the mechanism of crack initiation involved both single layer and a distributed multi-layer phenomenon and that multi-layer crack initiation delayed the crack initiation time for all loading conditions examined. The findings of this study support that the viscoelastic fracture theory governs fracture mechanics in crosslinked UHMWPE. The findings also support that crack initiation from a notch in UHMWPE is a more complex phenomenon than treated by traditional fracture theories for polymers.

Does vitamin E-stabilized ultrahigh-molecular-weight polyethylene address concerns of cross-linked polyethylene in total knee arthroplasty?

Concerns about reduced strength, fatigue resistance, and oxidative stability of highly cross-linked and remelted ultrahigh-molecular-weight polyethylene (UHMWPE) have limited its clinical acceptance for total knee arthroplasty. We hypothesized that a highly cross-linked UHMWPE stabilized with vitamin E would have less oxidation and loss of mechanical properties. We compared the oxidation, in vitro strength, fatigue-crack propagation resistance, and wear of highly cross-linked UHMWPE doped with vitamin E to γ-inert-sterilized direct compression-molded UHMWPE (control). After accelerated aging, the control material showed elevated oxidation, loss of small-punch mechanical properties, and loss of fatigue-crack propagation resistance. In contrast, the vitamin E-stabilized material had minimal changes and exhibited 73% to 86% reduction in wear for both cruciate-retaining and posterior-stabilized total knee arthroplasty designs. Highly cross-linked vitamin E-stabilized UHMWPE performed well in vitro.

The elimination of free radicals in irradiated UHMWPEs with and without vitamin E stabilization by annealing under pressure

Radiation crosslinking of ultrahigh molecular weight polyethylene (UHMWPE) has been used to decrease the wear of joint implant bearing surfaces. While radiation crosslinking has been successful in decreasing femoral head penetration into UHMWPE acetabular liners in vivo, postirradiation thermal treatment of the polymer is required to ensure the oxidative stability of joint implants in the long term. Two types of thermal treatment have been used: (i) annealing below the melting point preserves the mechanical properties but the residual free radicals trapped in the crystalline regions are not completely eliminated, leading to oxidation in the long-term and (ii) annealing above the melting point (melting) eliminates the free radicals but leads to a decrease in mechanical properties through loss of crystallinity during the melting process. In this study, we hypothesized that free radicals could be reduced by annealing below the melting point under pressure effectively without melting due to the elevation of the melting point. By avoiding the complete melting of UHMWPE, mechanical properties would be preserved. Our hypothesis tested positive in that we found the radiation-induced free radicals to be markedly reduced (below the detection limit of state-of-the-art electron spin resonance) by thermal annealing under pressure in radiation crosslinked virgin UHMWPE and UHMWPE/vitamin-E blends without loss of mechanical properties.

Effect of Lubricant Composition on the Fatigue Properties of Ultra-High Molecular Weight Polyethylene for Total Knee Replacement

Ultrahigh molecular weight polyethylene (UHMWPE) fatigue is a critical factor affecting the longevity of total knee replacement (TKR) bearings. With the increased need for laboratory studies to mimic near in vivo conditions for accurate characterization of material performance, the present study investigated the role of hyaluronic acid (HA) in testing lubricant on the crack growth response of UHMWPE. It was hypothesized that the change in lubricant viscosity as a result of HA would affect the fatigue life of the polymer. A fracture mechanics approach as per ASTM E 647 was adopted for this study. Surface micrograph and surface chemistry analyses were employed to study the micromechanisms of fatigue failure and protein adsorption of the specimen surfaces. Rheological analysis indicated that the addition of HA to diluted bovine serum increased testing lubricant viscosity. HA concentrations of 2.22, 0.55, and 1.5 g/1 closely matched the viscosity ranges reported for osteoarthritis, rheumatoid arthritic diseased joint fluid, and periprosthetic fluids respectively. Results showed that the addition of HA to standard diluted bovine serum lubricants, in concentrations similar to that of periprosthetic fluid, delayed crack initiation and crack growth during fatigue testing.

Cracking and impingement in ultra-high-molecular-weight polyethylene acetabular liners

The purpose of this study was to determine the prevalence of crack formation in conventional ultra-high-molecular-weight polyethylene cups and its association with rim impingement, oxidation, and time in situ. One hundred twenty acetabular cups were retrieved during revision total hip arthroplasty. In 40% (48/120) of the retrieved specimens, multiple subsurface cracks of several millimeters in length were revealed by transillumination. In 5 specimens, full thickness cracks led to fragmentation of the liner before revision. Thirty-eight (32%) liners had regions of moderate to severe impingement damage to the rim; cracks were initiated at the site of impingement in all but 1 liner (P < .0001). Cracks commonly occur in conventional ultra-high-molecular-weight polyethylene liners, often after neck impingement and almost always in association with oxidation of the polymer.

A review of current cross-linked polyethylenes used in total joint arthroplasty

Major improvements have been made in new polyethylenes in regards to wear resistance and oxidation resistance. The background for and explanation of these improvements are presented in this study. The various manufacturing processes are described along with the possible features that the differences in manufacturing processes may have on wear, rate of particle generation, oxidation and mechanical properties. The role of some of the new polyethylenes in permitting the use of larger-diameter heads and the advantages of large-head diameters are discussed. Some of the advantages of metal-on-polyethylene versus hard-on-hard bearings also are described.

Highly cross-linked polyethylene in cemented THA: randomized study of 61 hips

Highly cross-linked polyethylene (PE) has been introduced as an alternative bearing material in total hip arthroplasty (THA) because of high wear resistance in laboratory tests but the clinical experience of this material is limited. We evaluated a highly cross-linked PE (warm irradiated adiabatic melting, absorbed dose, 95 kGy) in a randomized study of cemented THAs. Cups of the same design but made of conventionally gamma irradiated PE (absorbed dose, 25-40 kGy) constituted the control group. Sixty-one hips (30 women, 30 men) with a median age of 55 years (range, 35-70 years) were included. All patients received a Spectron stem with 28-mm CoCr head. Radiostereometric examinations with the patient supine or standing were done at regular intervals. Wear was measured with the patient in the supine position from the first postoperative week, whereas examinations done with the patient standing were initiated 3 months after the operation. Dual x-ray absorptiometry and conventional radiography were used to evaluate the bone mineral density and the radiolucencies around the acetabular component. Fifty-two patients (53 hips; 25 highly cross-linked, 28 control) have been followed up for 2 years. At the 2-year followup, the highly cross-linked cups showed 50% reduction of proximal wear compared with the control group, when the patients were studied standing. When evaluated supine, the difference in proximal wear did not reach significance. The migration of the socket, the relative changes of periprosthetic bone mineral density, and the progression of radiolucencies between the immediately postoperative followup and 2-year followup did not differ. Highly cross-linked PE showed increase resistance to wear. Different mechanical properties of the two types of PE studied did not alter the performance of the cup in terms of fixation, periprosthetic bone loss, and radiographic appearance. However, the followup is short and these results are preliminary.

Multiaxial fatigue behavior of conventional and highly crosslinked UHMWPE during cyclic small punch testing

Previous observations of reduced uniaxial elongation, fracture resistance, and crack propagation resistance of highly crosslinked ultrahigh molecular weight polyethylene (UHMWPE) have contributed to concern that the technology may not be appropriate for systems undergoing cyclic fatigue loading. Using a "total life" approach, we examined the influence of radiation crosslinking on the fatigue response of UHMWPE under cyclic loading via the small punch test. Our goal in this study was to evaluate the suitability of the small punch test for conducting miniature-specimen, cyclic loading, and fatigue experiments of conventional and highly crosslinked UHMWPE. We subjected four types of conventional and highly crosslinked UHMWPE to cyclic loading at 200 N/s and at body temperature in a small punch test apparatus. After failure, the fracture surfaces were characterized with the use of field emission scanning electron microscopy to evaluate the fatigue mechanisms. Cyclic small punch testing under load control was found to be an effective and repeatable method for relative assessment of the fatigue resistance of conventional and highly crosslinked UHMWPE specimens under multiaxial loading conditions. For each of the four conventional and highly crosslinked UHMWPE materials evaluated in this study, fatigue failures were consistently produced according to a power law relationship in the low cycle regimen, corresponding to failures below 10000 cycles. The fatigue failures were all found to be consistent with a single source of initiation and propagation to failure. Our long-term goal in this research is to develop miniature-specimen fatigue testing techniques for characterization of retrieved UHMWPE inserts.

Numerical simulations on fatigue destruction of ultra-high molecular weight polyethylene using discrete element analyses

Ultra-high molecular weight polyethylene (UHMWPE) is a heterogeneous material composed of a networked substructure of grain boundary and grain aggregation. A new numerical model based on the discrete element method (DEM) was proposed to examine microscopic defect formation and propagation in UHMWPE. Numerical simulations were carried out using this model under two types of loading condition: unidirectional repetitive compression (simple loading) and bidirectional repetitive compression (switched loading). Subsurface defects were initiated and propagated in the vicinity of grain boundaries under both loading conditions. The defect propagation behavior was especially sensitive to grain boundary allocation under switched loading. An increase in defects was more rapid under switched loading than under simple loading. These numerical results showed qualitatively good agreement with experimental ones. It is suggested that the newly developed numerical method based on the DEM is a promising method to investigate fatigue behavior of a heterogeneous material such as UHMWPE under complicated loading conditions.

Why incongruous knee replacements do not fail early

Rapid failure of knee prostheses does not usually occur, despite the non-conforming nature of the articulation between femoral and tibial components and the associated large contact pressures. This theoretical study examines the likelihood of fatigue fracture of a layered elastic model loaded by a sliding cylindrical indenter. Cracks (line-defects) were assumed to have nucleated within the layer. The stress intensity factors (SIFs) associated with these cracks were calculated. The values obtained for the SIFs are quite low, with a corresponding low likelihood of crack-growth. When taken in conjunction with the experimentally derived fatigue laws of previous investigators, they suggest that short line-cracks should not grow. It seems that early failures have not simply been due to large shear stresses which occur beneath the prosthesis surface. Other factors, such as the degradation of material through heat-pressing, sterilisation or oxidation, or the deleterious effect of fusion defects, may be required to drive the cracks to delamination.

A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties. Recipient of the 1999 HAP Paul Award

Increasing cross-linking has been shown in vitro and in vivo to improve markedly the wear resistance of ultra-high-molecular-weight polyethylene (UHMWPE). The reduction in the mechanical properties of polyethylene under certain methods used to produce cross-linking has been a concern, however. These reductions are known to result from the processes used to increase the cross-link density and could affect the device performance in vivo. We present a novel method of increasing the cross-link density of UHMWPE in which UHMWPE is irradiated in air at an elevated temperature with a high-dose-rate electron beam and subsequently is melt-annealed. This treatment improves markedly the wear resistance of the polymer as tested in a hip simulator, while maintaining the mechanical properties of the material within national and international standards. This method leads to the absence of detectable free radicals in the polymer and, as a result, excellent resistance to oxidation of the polymer.

Study of fatigue resistance of chemical and radiation crosslinked medical grade ultrahigh molecular weight polyethylene

The aim of this work is to understand the role of chemical and radiation induced crosslinking on the fatigue crack propagation resistance of medical grade ultrahigh molecular weight polyethylene (UHMWPE). In recent years, the need to improve the tribological performance of UHMWPE used in total joint replacements has resulted in the widespread utilization of crosslinking as a method to improve wear resistance. Although crosslinking has been shown to drastically improve the wear resistance of the polymer, the potential trade-off in fatigue properties has yet to be addressed. Fatigue crack propagation resistance is a concern in tibial inserts where large cyclic stresses are sufficient to drive the growth of subsurface cracks that potentially contribute to delamination wear mechanisms. For clinical relevance, the combined effects of sterilization and aging are examined in two commercially available crosslinked resins. Nonsterile and unaged resins serve as a control. To evaluate the effect of crosslinking, a comparison is made to uncrosslinked resins. Scanning electron microscopy is used to provide an understanding of fatigue fracture mechanisms in the crosslinked polymers. The results of this study show that the current level of crosslinking used in orthopedic resins for enhanced wear resistance is not beneficial for fatigue crack propagation resistance.

Evolution of morphology in UHMWPE following accelerated aging: the effect of heating rates

Accelerated aging methods are used to evaluate the oxidative stability of UHMWPE components for total joint replacements. In this study, we traced the evolution of the crystalline morphology during accelerated thermal aging of UHMWPE in air with the intent of explaining previous, counterintuitive heating rate effects. GUR4150HP extruded rod stock material was machined into miniature (0.5 mm thick) specimens that were either gamma irradiated in air or in nitrogen (27 +/- 3 kGy) or left unirradiated (control). Accelerated aging in an air furnace (at 80 degrees C, atmospheric pressure) was performed on half of the test samples at a heating rate of 0.1 degrees C/min and at 5 degrees C/min for the remaining half. Although the initial heating rate, as measured by changes in density, did influence the absolute degradation rate by up to 214%, the heating rate effect did not appear to influence the relative ranking of UHMWPE in terms of its oxidative stability. The heating rate effect is more consistent with a kinetic mechanism of the oxidation process than it is with a previously hypothesized diffusion mechanism. UHMWPE morphology, as characterized using a transmission electron microscope (TEM), demonstrated considerable rearrangement of the crystalline regions as a result of the accelerated aging. The stacking of the lamellae observed after accelerated aging was not consistent with the morphology of naturally aged UHMWPE components. The observed differences in crystalline morphology likely result from the enhanced mobility of the polymer chains due to thermal aging and may be analogous to an annealing process.

The conflicting requirements of laxity and conformity in total knee replacement

Bearing surfaces of total condylar knees which are designed with a high degree of conformity to produce low stresses in the polyethylene tibial insert may be overconstrained. This study determines femoral and tibial bearing surface geometries which will induce the least destructive fatigue mechanisms in the polyethylene whilst conserving the laxity of the natural knee. Sixteen knee designs were generated by varying four parameters systematically to cover the range of contemporary knee designs. The parameters were the femoral frontal radius (30 or 70 mm), the difference between the femoral and tibial frontal radii (2 or 10 mm), the tibial sagittal radius (56 or 80 mm) and the posterior-distal transition angle (-8 or -20 degrees), which is the angle at which the small posterior arc of the sagittal profile transfers to the larger distal arc. Rigid body analyses determined the anterior-posterior and rotational motions as well as the contact points during the stance phase of gait for the different designs. In addition, a damage function which accumulated the fluctuating maximum shear stresses was used to predict the susceptibility to delamination wear of the polyethylene (damage score). This study predicted that of the 16 designs, the knee with a frontal radius of 70 mm, a difference in femoral and tibial frontal radii of 2 mm, a tibial sagittal radius of 80 mm and a posterior distal transition angle of -20 degrees would satisfy the conflicting needs of both resistance to delamination wear and natural kinematics.

Stress intensity factors for a vertical surface crack in polyethylene subject to rolling and sliding contact

Pitting wear is a dominant form of polyethylene surface damage in total knee replacements, and may originate from surface cracks that propagate under repeated tribological contact. In the present study, stress intensity factors, KI and KII, were calculated for a surface crack in a polyethylene-CoCr-bone system in the presence of rolling or sliding contact pressures. Variations in crack length and load location were studied to determine probable crack propagation mechanisms and modes. The crack tip experienced a wide range of mixed-mode conditions that varied as a function of crack length, load location, and sliding friction. Positive KI values were observed for shorter cracks in rolling contact and for all crack lengths when the sliding load moved away from the crack. KII was greatest when the load was directly adjacent to the crack (g/a = +/- 1), where coincidental Mode I stresses were predominantly compressive. Sliding friction substantially increased both KImax and KIImax. The effective Mode I stress intensity factors, Keff, were greatest at g/a = +/- 1, illustrating the significance of high shear stresses generated by loads adjacent to surface cracks. Keff trends suggest mechanisms for surface pitting by which surface cracks propagate along their original plane under repeated reciprocating rolling or sliding, and turn in the direction of sliding under unidirectional sliding contact.

Computer model to predict subsurface damage in tibial inserts of total knees

Two designs of total knee replacements were analysed to determine how the geometry of their bearing surface would affect the susceptibility of their ultra high molecular weight polyethylene tibial inserts to delamination. Orientations of the femoral components on the tibial surfaces were calculated with use of rigid body analysis for discrete intervals during the stance phase of gait. For each successive orientation, finite element analysis was used to compress the components together to determine the stresses in the tibial inserts. A damage function analogous to strain energy density was defined to account for the accumulated amplitudes and frequencies of the maximum shear stress cycles and hence to predict fatigue failure. The damage function was applied to each polyethylene element in the tibial insert, and the highest value calculated for each design was its damage score. One knee had a damage score more than three times less than that of the other because of lower stresses and because the contact points moved in the medial-lateral as well as anterior-posterior directions during internal-external rotation. The femoral and tibial components of this knee had large outer frontal radii and close conformity in the frontal plane. We propose that this method, which accounts for the motions and stresses endured during walking, makes different predictions regarding the likelihood of delamination compared with the predictions made by conventional static compression tests performed when the knee is in a neutral position.

Comparison of the effects of gamma radiation and low temperature hydrogen peroxide gas plasma sterilization on the molecular structure, fatigue resistance, and wear behavior of UHMWPE

The effects of gamma radiation and low temperature hydrogen peroxide gas plasma (HPGP) sterilization on structure and cyclic mechanical properties were examined for orthopedic grade ultra-high-molecular-weight polyethylene (UHMWPE) and compared to each other as well as to no sterilization (control). Density was monitored with a density gradient column and was found to be directly influenced by the sterilization method employed: Gamma radiation led to an increase, while plasma did not. Oxidation of the polymer was studied by observing changes in the carbonyl peak with Fourier transform infrared spectrometry and was found to be strongly affected by both gamma radiation and subsequent aging, while plasma sterilization had little effect. Gamma radiation resulted in embrittlement of the polymer and a decreased resistance to fatigue crack propagation. This mechanical degradation was a direct consequence of postradiation oxidation and molecular evolution of the polymer and was not observed in the plasma-sterilized polymer. Both gamma radiation and plasma sterilization led to improved wear performance of the UHMWPE compared to the nonsterile control material.

Morphology of rod stock and compression-moulded sheets of ultra-high-molecular-weight polyethylene used in orthopaedic implants

Compression-moulded sheets and extruded rods of ultra-high-molecular-weight polyethylene (UHMWPE) are currently used in the production of joint replacement prostheses. Crystallographic texture present in rods and sheets of UHMWPE was measured using a combination of small-angle X-ray scattering and wide-angle X-ray diffraction. Crystallographic texture can induce anisotropy in macroscopic properties of polymers, such as modulus and yield stress. Both rods and sheets of UHMWPE revealed a low but discernible degree of preferred orientation of polyethylene chains within crystallites. There was a spatial variation in crystallographic orientation in extruded rods. The direction of chain alignment within crystallites located near the outer surface of rods was orthogonal to the radial direction, whereas the chain direction was orthogonal to the axial or extrusion direction in crystallites located near the centreline of extruded rods. Crystallographic texture was spatially uniform in compression-moulded sheets with the chain direction within crystallites aligned orthogonal to the moulding direction. In both cases the induced crystallographic texture can be explained in terms of crystallization from an oriented melt.

The porous-coated anatomic total hip prosthesis: failure of the metal-backed acetabular component

One hundred and ninety-nine total hip arthroplasties were performed, between 1983 and 1987, in 173 patients by three surgeons using the initial design of the porous-coated anatomic prosthesis. The acetabular component was a preassembled, metal-backed polyethylene device, with beads sintered to the metal backing to allow bone ingrowth and two pegs for initial fixation. Twenty-three acetabular components (12 percent) failed because of either migration or severe osteolysis. The radiographic appearance of osteolysis was positively associated with the duration that the implant had been in situ (p < 0.001). The prevalence of osteolysis was also significantly greater in acetabular components with an outer diameter of fifty-five millimeters or less (a polyethylene thickness of 8.5 millimeters or less) (p = 0.03). Thirteen hips were revised at a mean of 69.5 months (range, thirty-three to ninety-one months) after the index operation. Examination of the retrieved acetabular components revealed extensive polyethylene damage on the articular and back surfaces of the liners. Cracks in the polyethylene rim of the liner and deformation of the anti-rotation notch in the polyethylene rim were common findings. The density of the polyethylene was greater than expected, and more particles than anticipated had not fused with the surrounding polyethylene. The results of this study suggest that factors related to both the design and the material contributed to the failure of these porous-coated anatomic acetabular components.