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T he interface between the liner and the metallic acetabular shell of a THA is a potential source of polyethylene (PE) particles, in a process called backside wear. Its role in periprosthetic osteolysis is not as well established as those of the bearing surface. Although a high frequency of retroacetabular osteolysis and poor survivorship have been reported with uncemented implants in certain modular cup designs [4], no correlation could be established between backside damage scores and acetabular or femoral osteolysis [3]. Highly crosslinked PE (HXLPE) for THA has been shown to decrease wear of the articular surface at 10 years and more in many studies, but the study here by Bali et al. is interesting because it looked carefully at backside wear. This group analyzed the backside surface of 233 retrieved acetabular conventional (CPE) and HXLPE liners from two different socket designs. HXLPE liners exhibited higher resistance to backside changes compared to CPE, including in the liner group from shells with a roughened inner surface and a suboptimal locking mechanism. The work by Bali et al. reports innovative clinical data, showing that backside surface damage could be dramatically improved in HXLPE liners. The lack of control and heterogeneous times of implantation represent the main limitations of the study. Also, no quantitative evaluation of PE wear and osteolysis was performed, making impossible to define an osteolytic threshold related to backside wear. However, the current data support the possibility of an isolated liner revision using a HXLPE insert where a well-fixed socket might be retained.

CORR Insights®: Backside Wear Is Not Dependent on the Acetabular Socket Design in Crosslinked Polyethylene Liners