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Bearing Surfaces
Although total hip arthroplasty (THA) is highly successful in most patients, the increasing use of the procedure in patients younger than 60 years with high activity demands and increased life expectancy has raised concerns related to bearing surfaces. A higher prevalence of periprosthetic osteolysis and aseptic loosening has been observed in these patients. These concerns have prompted the search for bearing surfaces with favorable wear properties that minimize wear rates and decrease adverse local tissue reactions to particulate debris. The current success rates of THA are largely the result of improvements in bony integration surfaces, sterilization processes, and articular surface properties that have resulted in increased implant longevity. However, these advancements in implant design have brought new challenges. To address articular wear, a wide variety of bearing surfaces has been used with varied success. Surface materials include polytetrafluoroethylene, ultrahigh– molecular-weight polyethylene (UHMWPE, including variations such as carbon fiber–reinforced and extended chain recrystallized), ceramics, titanium alloys (including nitrided and ion-implanted versions), cobalt-chromium (CoCr) alloys, oxygen diffusion–hardened zirconium alloy, and highly cross-linked polyethylene (XLPE).