Tribological Failure in Modern Total Hip Arthroplasty: A Narrative Review of Third-Body Wear, Oxidative Degradation, and Cross-Linked Polyethylene Longevity

Tribological failure remains a leading cause of revision in total hip arthroplasty (THA). Wear particles-mediated osteolysis, oxidative degradation of polyethylene, and surface damage to bearing materials contribute to mechanical loosening and long-term implant failure. This narrative review focuses on the mechanisms of tribological failure in contemporary THA and evaluates how advances in biomaterials such as highly cross-linked polyethylene, ceramic bearings, and dual-mobility constructs influence long-term implant survivorship. Highly cross-linked polyethylene has substantially reduced wear rates and osteolysis compared to conventional ultra-high-molecular-weight polyethylene (UHMWPE) but remains vulnerable to oxidative aging and fatigue cracking under certain conditions. Ceramic-on-ceramic bearings demonstrate excellent wear resistance but may present complications such as squeaking and liner fracture. Metal-on-metal bearings, once promising for low wear, have been largely abandoned due to taper corrosion and systemic metal ion reactions. Dual-mobility constructs reduce instability and dislocation but can exhibit backside wear if component positioning or polyethylene quality is suboptimal. Material and design innovations have improved tribological performance in THA, yet no bearing surface is free of trade-offs. Understanding the interaction between materials science and mechanical loading remains critical for extending implant longevity and reducing revision rates.