Biomechanics, Material Performance, and Wear Analysis in Total Hip Arthroplasty: A Review

Total hip arthroplasty (THA) is a transformative procedure for managing severe hip disorders, yet implant longevity remains a critical challenge, particularly for younger, active patients. Wear-related complications are a leading cause of revision surgery, emphasizing the need for optimized design and material performance. This systematic review aims to synthesize evidence on the wear behavior, material properties, and design parameters of hip implants with a focus on finite element analysis (FEA)-based predictive approaches. A comprehensive literature search was conducted across Scopus, PubMed, ScienceDirect, MDPI, and Cochrane databases following PRISMA guidelines. Studies published between 2010 and 2025 were included if they addressed THA biomechanics, wear analysis, or material optimization using FEA, hip simulators, or radiostereometric techniques. Key findings reveal that larger femoral heads, while reducing contact pressure, increase wear due to greater sliding distance. Gravimetric wear rates ranged from 3.15 ± 0.27 mg/Mc to 2.18 ± 0.31 mg/Mc, while linear and volumetric wear reached 0.0375 mm/Mc and 33.6 mm3/Mc, respectively. Stress analysis showed custom stems exhibited markedly lower von Mises stress (194.9 MPa) compared to standard designs (664.3 MPa), and fatigue assessments confirmed a factor of safety > 1 across profiles. Patient-specific factors, such as body weight, significantly influenced wear with a 26% increase in metal wear observed between 100 kg and 140 kg. This systematic review synthesizes current research on total hip arthroplasty, emphasizing biomechanical and material factors critical for implant longevity and patient care. It uniquely integrates FEA-based wear prediction with clinical implications, bridging computational modeling, geometry optimization, and material performance to provide actionable insights for next-generation, patient-specific hip implant design.