{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T13:00:39Z","timestamp":1767963639024,"version":"3.49.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Orthop Relat Res"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Oxidized zirconium (OxZr) femoral heads were introduced in hip arthroplasty to reduce wear of the polyethylene compared with metallic heads and to reduce fracture risk compared with ceramic heads. Severe scratches have been reported on OxZr heads in patients undergoing revision for instability, but whether these scratches contribute to increased acetabular polyethylene wear remains unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Questions\/purposes<\/jats:title>\n            <jats:p>(1) How is the polyethylene of the acetabular liner affected by damage on the opposing OxZr head? (2) How does damage to the head affect the degree of polyethylene wear?<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We assessed damage and deformation on all retrieved highly crosslinked liners that had articulated against OxZr heads collected at one institution between 2006 and 2013. Two observers used a visual subjective scoring system to assess polyethylene damage on the surface of the 42 retrieved liners. Polyethylene components were also laser scanned to measure dimensional changes to the liner. These outcomes were compared with the severity of scratching on the surface of the articulating OxZr head. We also used a 12-station hip simulator to measure wear over five million cycles (MCs) of pristine liners articulating against nine retrieved OxZr heads with varying degrees of scratching representing a spectrum of little to severe damage and three retrieved ceramic heads with severe metal transfer.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Seventeen of the OxZr heads showed severe damage, of which 14 heads had been revised for dislocation. The retrieved liners that had articulated with these heads had greater damage scores for abrasion (mean score 0.4 versus 1.6; p = 0.008) and embedded debris (mean score 0.4 versus 1.4; p = 0.006) compared with liners that had articulated with less damaged heads. Four severely damaged OxZr heads wore at a higher rate than the others in the study with weight loss of 37.7 mg, 30.0 mg, 14.4 mg, and 2.6 mg after the first MC and a steady increase through testing to 5 MCs. Conversely, neither OxZr heads with less damage nor ceramic heads with severe metal transfer produced appreciable wear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Surface scratching of OxZr heads from recurrent dislocation and reduction maneuvers leads to increased wear of the crosslinked polyethylene used as a bearing surface.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Relevance<\/jats:title>\n            <jats:p>Patients in whom such instability occurs in the presence of an OxZr head should be followed closely for the possibility of more severe wear.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11999.0000000000000040","type":"journal-article","created":{"date-parts":[[2018,2,21]],"date-time":"2018-02-21T13:47:55Z","timestamp":1519220875000},"page":"182-192","source":"Crossref","is-referenced-by-count":14,"title":["Polyethylene Wear Increases in Liners Articulating With Scratched Oxidized Zirconium Femoral Heads"],"prefix":"10.1097","volume":"476","author":[{"given":"Alberto","family":"Carli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsea N.","family":"Koch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina I.","family":"Esposito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy M.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas E.","family":"Padgett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2018,1,17]]},"reference":[{"key":"R1-20230814","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1002\/jbm.b.30318","article-title":"Validation of a micro-CT technique for measuring volumetric wear in retrieved acetabular liners","volume":"75","author":"Bowden","year":"2005","journal-title":"J Biomed Mater Res B Appl Biomater."},{"key":"R2-20230814","first-page":"43","article-title":"Ceramic bearings in total hip replacement: a retrieval analysis","volume":"61","author":"Chen","year":"2010","journal-title":"Minerva Ortop Traumatol"},{"key":"R3-20230814","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/00003086-199309000-00053","article-title":"Characteristics of metal and ceramic total hip bearing surfaces and their effect on long-term ultra high molecular weight polyethylene wear","volume":"294","author":"Davidson","year":"1993","journal-title":"Clin Orthop Relat Res."},{"key":"R4-20230814","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1002\/jbm.820170510","article-title":"Retrieval analysis of total knee prostheses: a method and its application to 48 total condylar prostheses","volume":"17","author":"Hood","year":"1983","journal-title":"J Biomed Mater Res."},{"key":"R5-20230814","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.arth.2008.07.009","article-title":"Surface oxidized zirconium total hip arthroplasty head damage due to closed reduction effects on polyethylene wear","volume":"24","author":"Jaffe","year":"2009","journal-title":"J Arthroplasty"},{"key":"R6-20230814","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1302\/0301-620X.97B7.35285","article-title":"Five-year comparison of wear using oxidised zirconium and cobalt-chrome femoral heads in total hip arthroplasty: a multicentre randomised controlled trial","volume":"97","author":"Jassim","year":"2015","journal-title":"Bone Joint J."},{"key":"R7-20230814","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1302\/0301-620X.97B11.36137","article-title":"Oxinium modular femoral heads do not reduce polyethylene wear in cemented total hip arthroplasty at five years: a randomised trial of 120 hips using radiostereometric analysis","volume":"97","author":"Jonsson","year":"2015","journal-title":"Bone Joint J."},{"key":"R8-20230814","doi-asserted-by":"crossref","first-page":"3836","DOI":"10.1007\/s11999-015-4503-7","article-title":"Oxidized zirconium head on crosslinked polyethylene liner in total hip arthroplasty: a 7- to 12-year in vivo comparative wear study","volume":"473","author":"Karidakis","year":"2015","journal-title":"Clin Orthop Relat Res."},{"key":"R9-20230814","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.arth.2006.07.005","article-title":"Damage of oxinium femoral heads subsequent to hip arthroplasty dislocation three retrieval case studies","volume":"22","author":"Kop","year":"2007","journal-title":"J Arthroplasty"},{"key":"R10-20230814","doi-asserted-by":"crossref","first-page":"3270","DOI":"10.1007\/s11999-013-3096-2","article-title":"Do ceramic femoral heads reduce taper fretting corrosion in hip arthroplasty? A retrieval study","volume":"471","author":"Kurtz","year":"2013","journal-title":"Clin Orthop Relat Res."},{"key":"R11-20230814","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.arth.2016.08.011","article-title":"Incidence of modern alumina ceramic and alumina matrix composite femoral head failures in nearly 6 million hip implants","volume":"32","author":"Lee","year":"2017","journal-title":"J Arthroplasty"},{"key":"R12-20230814","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s11999-015-4344-4","article-title":"Surface damage is not reduced with highly crosslinked polyethylene tibial inserts at short-term","volume":"474","author":"Liu","year":"2016","journal-title":"Clin Orthop Relat Res."},{"key":"R13-20230814","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1302\/0301-620X.93B3.25327","article-title":"Damage of an Oxinium femoral head and polyethylene liner following \u2018routine' total hip replacement","volume":"93","author":"McCalden","year":"2011","journal-title":"J Bone Joint Surg Br."},{"key":"R14-20230814","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/jor.1100170203","article-title":"Development of an extremely wear-resistant ultra high molecular weight polyethylene for total hip replacements","volume":"17","author":"McKellop","year":"1999","journal-title":"J Orthop Res."},{"key":"R15-20230814","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1002\/jor.1100170306","article-title":"Effect of molecular weight, calcium stearate, and sterilization methods on the wear of ultra high molecular weight polyethylene acetabular cups in a hip joint simulator","volume":"17","author":"McKellop","year":"1999","journal-title":"J Orthop Res."},{"key":"R16-20230814","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.arth.2014.10.036","article-title":"Hip dislocation increases roughness of oxidized zirconium femoral heads in total hip arthroplasty: an analysis of 59 retrievals","volume":"30","author":"Moussa","year":"2015","journal-title":"J Arthroplasty"},{"key":"R17-20230814","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1054\/arth.2001.20540","article-title":"A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties. 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