A Geometric Analysis of Polyethylene Liners Exposed to Acrylic-based Bone Cement

Background: Acrylic-based bone cement (polymethyl methacrylate [PMMA]) is a material commonly used in orthopaedic surgeries; however, during PMMA polymerization, a highly exothermic reaction occurs. The heat released in polymerization can damage nearby materials including poorly heat-resistant cross-linked polyethylene (XLPE). Both PMMA and XLPE are used in total hip arthroplasty and could interact during femoral stem fixation. We sought to determine if the exothermic polymerization of PMMA could alter the surface characteristics of XLPE acetabular liners. Methods: Six XLPE liners were assigned to one of 4 experimental categories with varying volumes of PMMA applied in a manner that mimicked how the 2 materials would come into contact intra-operatively. Measurements were taken both pre-and post-intervention using a coordinate measuring machine for geometric and gravimetric analysis. Light microscopy was conducted postintervention to examine the surface for damage.Results: Coordinate measuring machine measurements showed minimal gross deformation in all 6 liners, but there were isolated surface deposits in 4 of 6 liners. The average maximal surface deviations, when compared to the control, for liners exposed to 1 cc of cement, 2 cc of cement, or 1 cc of cement with a femoral head implant attached were 26.6 mm, 77.2 mm, and 26.4 mm, respectively. All but one liner showed an increase in volume following intervention when compared to the control. Subtle scratches were identified using light microscopy on all 6 liners. Conclusions: XLPE shows areas of isolated surface deformation in a dose-dependent manner but with minimal gross deformation after interacting with highly exothermic PMMA.(c) 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/ 4.0/).