Dr. Streicher's response to Drs. Walker and Blunn

Abstract

Although not so stated in their arguments, Drs. Walker and Blunn probably agree that osteolysis initiated by adverse tissue reactions, primary to wear particles and by-products, is a major concern for the long-term outcome of total hip arthroplasty (THA). We are therefore arguing about solving the same problem, but with a different approach. There really is no argument. Drs. Walker and Blunn are advocating the general use of ultrahigh-molecular-weight polyethylene (UHMWPE) in all patients. I make a point for THA with hard-hard, especially metal-metal, articulation only where it makes economic and logical sense, for the high-demand patient. My investigations of the last 15 years were focused on the possibilities of wear reduction. As a result, several improvements for the THA with UHMWPE articulation were introduced during the midand late 1980s. These included specially synthesized and calcium stearate-free medical-grade UHMWPE; gamma sterilization, annealing, and storage in inert gas; alternative ceramics and the development of diffusion-hardened t i tanium alloy, especially for knee joint implants. Drs. Walker and Blunn point out the benefits of using articulations with UHMWPE, but they address the evident drawbacks with the use of this material only in part. Although clinical results have demonstrated that UHMWPE can achieve its intended purpose generally for a limited time, its long-term performance must still be questioned because of its inherent flaws and its vulnerability: