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Jalali O, Fiske J, DeJardin MG, Scudday TS, Barnett SL, Gorab RS. Wear of Third-Generation Cross-Linked Polyethylene in Primary Total Hip Arthroplasty: A 10-Year Analysis. J Arthroplasty 2024; 39:1335-1340. [PMID: 37977306 DOI: 10.1016/j.arth.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sequential modifications to the manufacturing process of highly cross-linked polyethylene (HXLPE) have improved the wear resistance and implant survival of these liners in total hip arthroplasty (THA). However, no study has examined the long-term (mean 10 year) wear rates and clinical outcomes of third-generation HXLPE in THA. The aim of our study was to report the longest-to-date analysis of wear rates and clinical outcomes of a third-generation HXLPE liner. METHODS A series of 133 THAs using a specific HXLPE acetabular liner were retrospectively evaluated. Linear and volumetric wear rates were determined using a validated radiographic technique and clinical outcomes were analyzed. Multivariate analyses were performed to determine risk factors for accelerated wear. RESULTS At a mean follow-up of 10.4 years (range, 8 to 13.4), the mean linear wear rate was 0.0172 mm/year and the mean volumetric wear rate was 16.99 mm3/year. There were no instances of osteolysis or mechanical failures at any time point and there was a 100% acetabular component survival rate. Younger age and use of offset liners were independent risk factors for increased wear (P < .01 for both). CONCLUSIONS Our series of a third-generation HXLPE demonstrated very low wear rates and excellent implant survival at a mean of 10.4 years following primary THA. Future comparative studies at the 15- and 20-year follow-up timepoints are necessary to determine if such findings translate to true improvements in the tribological properties and longevity of these liners when compared to previous generations of HXLPE liners.
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Affiliation(s)
- Omid Jalali
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California
| | - Joseph Fiske
- College of Osteopathic Medicine, Touro University California, Vallejo, California
| | | | - Travis S Scudday
- Department of Orthopaedic Surgery, Hoag Orthopedic Institute, Irvine, California
| | - Steven L Barnett
- Department of Orthopaedic Surgery, Hoag Orthopedic Institute, Irvine, California
| | - Robert S Gorab
- Department of Orthopaedic Surgery, Hoag Orthopedic Institute, Irvine, California
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Bieganowski T, Singh V, Muthusamy N, Kugelman DN, Davidovitch RI, Schwarzkopf R. Short-term outcomes of thin highly cross-linked polyethylene liners in primary total hip arthroplasty. Hip Int 2023; 33:839-844. [PMID: 36124343 DOI: 10.1177/11207000221123905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The use of thin highly cross-linked polyethylene (HXLPE) liners in total hip arthroplasty (THA) allows utilisation of larger femoral heads. However, concern surrounding postoperative complications remains. This study aims to investigate rates of revision and re-admission associated with thin HXLPE liners at short-term follow-up. METHODS We retrospectively reviewed 3047 patients who underwent THA with a cementless modular acetabular implant with a 36-mm femoral head, and different thicknesses of HXPLE liners from 2011 to 2021. We identified 723 patients (23.7%) with a minimum 2-year follow-up and 206 patients (6.8%) with a minimum 5-year follow-up. Patients in the thin group (TG, n = 1020) received <5.1-mm liners with 52-mm size cups while patients in the non-thin group (NTG, n = 2027) received >5.1-mm liners with >52-mm size cups. Outcomes were compared using multi-variable logistic regressions while controlling for all significant demographic differences. RESULTS We found no significant differences in re-admission (3.9% vs. 4.3%, OR 0.97; 95% CI, 0.63-1.49; p = 0.874) and revision (2.5% vs. 3.2%, OR 0.72; 95% CI, 0.41-1.26; p = 0.246) rates between groups. The difference in fracture rate between groups was not significant, but the 1 recorded acetabular fracture (5%) occurred in the NTG. Although the rate of liner exchange was lower in the TG (1.1%) compared to the NTG (2.3%), the difference was not statistically significant (OR 0.51; 95% CI, 0.24-1.05; p = 0.068). Liners were exchanged for liner wear in 1 hip (1%), aseptic reasons in 38 hips (66%), and peri-prosthetic joint infection in 19 hips (33%). CONCLUSIONS Patients undergoing THA with a thin liner were not significantly predisposed to higher rates of revision surgery or poorer clinical outcomes at short-term follow-up when compared to those who received a thicker liner. Consequently, further long-term studies regarding the utility of thin HXLPE implants in reducing complications should be pursued.
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Affiliation(s)
- Thomas Bieganowski
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Vivek Singh
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Nishanth Muthusamy
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - David N Kugelman
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Roy I Davidovitch
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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Curtin M, Pomeroy E, Grigoras M, Murphy T, Rowan FE. A prospective osseointegration retrieval analysis of second generation cementless shells. J Clin Orthop Trauma 2022; 30:101914. [PMID: 35734018 PMCID: PMC9207567 DOI: 10.1016/j.jcot.2022.101914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/22/2022] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
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Yakkanti RR, Ocksrider JL, Patel AA, Kolevar MP, Moore RD, Rimnac CM, Kraay MJ, Wright TM, Baral EC, Robinson RP. Unexpected Wear of a Uniquely Designed Moderately Cross-Linked Polyethylene in Total Hip Arthroplasty. J Arthroplasty 2022; 37:1130-1135. [PMID: 35131388 DOI: 10.1016/j.arth.2022.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A uniquely designed, non-heat-treated moderately cross-linked acetabular polyethylene liner used in total hip arthroplasty (THA) demonstrated excessive wear during routine follow-up, prompting an evaluation of the linear wear rate. METHODS All THAs were performed by the senior author. The study group included 38 THAs using the uniquely designed polyethylene in question, compared to a control group of 21 THAs using another moderately cross-linked polyethylene with good 10-year outcomes. Two-dimensional linear head penetration wear measurements were obtained using the Martell Hip Analysis Suite, and retrieval analysis was performed on two liners. RESULTS The study group had a significantly higher average penetration rate of 0.089 mm/y than the control group average rate of 0.047 mm/y (P = .04). Forty-five percent of the study group had a wear rate above the osteolysis threshold (0.1 mm/y), compared to 24% in the control group. Macroscopic analysis of two retrieved liners validated the radiographic findings. CONCLUSION The data suggest unexpectedly higher wear rates for a moderately cross-linked polyethylene design, with nearly half of the study group at risk for osteolysis. Further registry or database analyses of this particular moderately cross-linked polyethylene are warranted.
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Affiliation(s)
- Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, University of Miami / Jackson Memorial Health System, Miami, FL
| | - Justin L Ocksrider
- Department of Orthopaedic Surgery, University of Miami / Jackson Memorial Health System, Miami, FL
| | - Anand A Patel
- Summit Medical Group of New Jersey, Florham Park, NJ
| | | | | | | | | | | | | | - Raymond P Robinson
- Department of Orthopaedic Surgery, University of Miami / Jackson Memorial Health System, Miami, FL
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Orita K, Goto K, Kuroda Y, Kawai T, Okuzu Y, Matsuda S. Wear resistance of first-generation highly cross-linked annealed polyethylene in cementless total hip arthroplasty is maintained 20 years after surgery. Bone Joint J 2022; 104-B:200-205. [PMID: 35094568 DOI: 10.1302/0301-620x.104b2.bjj-2021-1079.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS The aim of this study was to evaluate the performance of first-generation annealed highly cross-linked polyethylene (HXLPE) in cementless total hip arthroplasty (THA). METHODS We retrospectively evaluated 29 patients (35 hips) who underwent THA between December 2000 and February 2002. The survival rate was estimated using the Kaplan-Meier method. Hip joint function was evaluated using the Japanese Orthopaedic Association (JOA) score. Two-dimensional polyethylene wear was estimated using Martell's Hip Analysis Suite. We calculated the wear rates between years 1 and 5, 5 and 10, 10 and 15, and 15 and final follow-up. RESULTS The mean follow-up period was 19.1 years (SD 0.6; 17.3 to 20.1). The 19-year overall survival rate with the end point of all-cause revision was 97.0% (95% confidence interval (CI) 91 to 100). The mean JOA score improved from 43.2 (SD 10.6; 30 to 76) before surgery to 90.2 (SD 6.4; 76 to 98) at the final follow-up (p < 0.001). There was no osteolysis or loosening of the acetabular or femoral components. The overall steady-state wear rate was 0.013 mm/year (SD 0.012). There was no hip with a steady-state wear rate of > 0.1 mm/year. There was no significant difference in wear rates for each period. We found no significant correlation between the wear rate and age, body weight, BMI, or cup inclination. CONCLUSION First-generation annealed HXLPE shows excellent wear resistance and no acceleration of wear for approximately 20 years, with low all-cause revision rates. Cite this article: Bone Joint J 2022;104-B(2):200-205.
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Affiliation(s)
- Kazuki Orita
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Yaichiro Okuzu
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Hospital, Kyoto, Japan
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Jalali O, Scudday T, Fickenscher MC, Barnett S, Gorab R. Third-Generation Medium Cross-Linked Polyethylene Demonstrates Very Low Wear in Total Hip Arthroplasty. Arthroplast Today 2020; 6:316-321. [PMID: 32514421 PMCID: PMC7267711 DOI: 10.1016/j.artd.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/21/2020] [Accepted: 04/07/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cross-linked polyethylene (XLPE) liners have shown lower wear rates than conventional polyethylene liners in total hip arthroplasty. The primary aim of our study was to report our most recent analysis of wear rates and clinical outcomes of a third-generation XLPE liner. Secondary aims were to investigate the rate of adverse events related to mechanical failure or oxidation of this liner. Methods A series of 266 total hip arthroplasties using a specific XLPE liner were retrospectively reviewed. Radiographs were examined to determine linear and volumetric wear rates and presence of osteolysis. Clinical outcomes, revision rates, mechanical failures, and risk factors for accelerated polyethylene wear were additionally investigated. Results The mean age at the time of surgery was 65.8 years and the mean follow-up was 5.5 years. The mean linear wear rate was 0.003 mm/year and the mean volumetric wear rate was 0.42 mm3/year, and there was no evidence of osteolysis. Harris hip scores increased from 50.9 preoperatively to 96.0 at the latest follow-up. The revision rate was 0.4%, with no liner rim fractures and no liner dissociations/loosenings. Femoral head material, head size, age, body mass index, and time since implantation had no effect on wear rates. Conclusion Wear rates for this third-generation XLPE liner were low at mid-term follow-up, and no adverse sequelae of oxidation or deleterious mechanical properties were observed. This remained true regardless of femoral head size and material or patient age and body mass index. Further analysis will be necessary to ensure continued wear resistance, oxidative stability, and mechanical strength at long-term follow-up.
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Affiliation(s)
- Omid Jalali
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Shin WC, Moon NH, Jeon SB, Suh KT. Comparison of Surgical Outcomes Between Standard and Elevated-Rim Highly Cross-Linked Polyethylene Acetabular Liners in Primary Total Hip Arthroplasty With Minimum 15-Year Follow-Up: Single-Center, Retrospective Cohort Study. J Arthroplasty 2020; 35:1290-1296. [PMID: 31983565 DOI: 10.1016/j.arth.2019.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aims of the present study are to (1) conduct the longest-to-date follow-up wear analysis of the highly cross-linked polyethylene acetabular liners, (2) assess the incidence of femoral and acetabular osteolysis, and (3) compare the surgical outcomes between standard and elevated-rim acetabular liners in primary total hip arthroplasty (THA). METHODS In this retrospective cohort study, we evaluated 112 primary THAs performed by a single experienced arthroplasty surgeon at our institution between March 2000 and December 2003. Patients were classified based on the type of acetabular liner used: standard or elevated-rim liner. For evaluation of surgical outcomes, the following data were collected: acetabular cup position (anteversion and inclination), wear rate (linear and volumetric), presence of osteolysis, history of reoperation (all-cause and wear-related), complications (deep joint infection, dislocation, and periprosthetic fracture), and Harris hip score at last follow-up. RESULTS Linear and volumetric wear rates were 0.028 mm/y (0.000-0.145 mm/y) and 11.641 mm3/y (0.000-70.000 mm3/y) in the standard group and 0.026 mm/y (0.000-0.094mm/y) and 9.706 mm3/y (0.000-33.000 mm3/y) in the elevated-rim group, respectively. These rates were not significantly different between groups. One case of osteolysis was confirmed in the standard group, whereas no osteolysis was observed in the elevated-rim group. CONCLUSION We suggest that elevated-rim highly cross-linked polyethylene acetabular liners might be a good implant option that can be used safely.
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Affiliation(s)
- Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Se Bin Jeon
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Klasan A, Neri T, Sen A, El-Zayat BF, Efe T, Lahner M, Heyse TJ. Titanium acetabular cementless cups combined with highly crosslinked polyethylene liner have very low rates of aseptic loosening. Technol Health Care 2019; 28:415-423. [PMID: 31796715 DOI: 10.3233/thc-191896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a clear tendency towards cementless acetabular components in primary total hip arthroplasty. OBJECTIVE The aim of this study was to assess the long-term clinical and radiological outcome of titanium cementless acetabular cups when combined with a highly crosslinked polyethylene liner. METHODS This study is a retrospective follow-up of 67 cups in 64 patients. Clinical outcomes were assessed using the Harris Hip Score. Radiolucent lines, osteolysis and loosening were assessed radiologically. Implant survival was determined using the Kaplan-Meier analysis. RESULTS The average Harris Hip Score at follow-up was 80.3 ± 14.5. Signs of osteolysis were observed in 7.1% of the radiographs. No aseptic loosening of the cup was reported. Survival of the cup with aseptic loosening as an endpoint was 100%. A comparison with 19 other studies using the same material combination demonstrated very similar results. All manufacturers with available studies have at least one report of 100% survivorship at 10-year follow-up for their titanium cup and highly crosslinked polyethylene acetabular component combination with aseptic loosening as an endpoint. CONCLUSIONS The data suggests that the rate of aseptic loosening of a titanium cup combined with a highly-crosslinked polyethylene liner at 10-year follow-up could be as low as 0%.
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Affiliation(s)
- Antonio Klasan
- University Hospital Marburg, Center for Orthopedics and Traumatology, Baldingerstrasse, 35043 Marburg, Germany
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital of Saint Etienne, France
| | - Ahmet Sen
- Clinic Jung-Stilling, Department for Trauma, Siegen, Germany
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Feng JE, Novikov D, Chen K, Kim K, Bookman J, Anoushiravani AA, Hamula M, Snir N, Schwarzkopf R. Up to 18-Year Follow-Up Wear Analysis of a First-Generation Highly Cross-Linked Polyethylene in Primary Total Hip Arthroplasty. J Arthroplasty 2018; 33:3325-3328. [PMID: 30041989 DOI: 10.1016/j.arth.2018.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/23/2018] [Accepted: 06/07/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The advent of highly cross-linked polyethylene (HCLPE) has significantly improved total hip arthroplasty survivorship. HCLPE has been shown to improve wear properties in midterm outcomes when compared to traditional polyethylene liners; however, there is a paucity of studies evaluating long-term outcomes. In addition, there is concern that wear rates may accelerate as the implant ages. Thus, the aims of this study are to report on the longest-to-date follow-up of a specific first-generation HCLPE liner and to determine whether there is a change in the annual wear rate over time. METHODS Forty hips in 38 patients which were previously reported on in a midterm study were included in this long-term follow-up study. Patients in this cohort all received total hip arthroplasty between March 1999 and August 2004 using the Crossfire HCLPE liner. Annual wear rates (mm/y) were calculated for this cohort. Patients were contacted and asked about complications or revision procedures they may have had since the index procedure. RESULTS Clinical follow-up averaged 12.9 years with a range of 7-18 years. The average follow-up duration was 12.5 years with a range of 10-17 years. Linear wear was found to be 0.056 ± 0.036 mm/y. Osteolysis was not observed in any of the patients with greater than 10-year radiographic follow-up. Furthermore, only 1 patient required revision surgery following a mechanical fall. CONCLUSION Our study demonstrates the long-term wear rates associated with HCLPE liners continue to match rates published in midterm studies. Previously, we have reported that this cohort had an average annual wear rate of 0.05 mm/y over 10 years. This most recent report demonstrates a similar wear rate with up to 18-year follow-up.
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Affiliation(s)
- James E Feng
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - David Novikov
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Kevin Chen
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Kelvin Kim
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Jared Bookman
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | | | - Matthew Hamula
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
| | - Nimrod Snir
- Division of Adult Reconstruction, Department of Orthopaedics, Sorasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY
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Abstract
Generation of wear debris and wear particle-induced osteolysis are the main limitations of metal-on-polyethylene artificial joints. Cross-linked polyethylene has been recently used, particularly in hip replacements, as an alternative material to conventional ultrahigh molecular weight polyethylene due to its superior wear resistance. This study focused on the wear behaviour of cross-linked polyethylene under different contact stresses in order to make interpretations of its long-term in-vivo performance. A 50-station SuperCTPOD (pin-on-disc) machine was used to investigate the influence of contact stress on the wear of cross-linked polyethylene pins which were articulated against cobalt chromium discs. It was found that the wear rate of cross-linked polyethylene was lower at higher contact stresses.
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Affiliation(s)
- Göksu Kandemir
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Smith
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas J Joyce
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
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Mayer C, Rommelmann M, Behringer M, Jäger M, Krauspe R, Zilkens C. Wear Kinetics of Highly Cross-Linked and Conventional Polyethylene Are Similar at Medium-term Follow-Up After Primary Total Hip Arthroplasty. J Arthroplasty 2018; 33:2671-6. [PMID: 29699828 DOI: 10.1016/j.arth.2018.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Wear debris is a major factor in aseptic loosening of total hip arthroplasty. Ultra high molecular weight polyethylene inlays are known for significant wear, and the following generation, highly cross-linked polyethylene (HCLPE), has shown promising in vitro and short-term in vivo results. This study aimed to investigate wear debris of HCLPE liners with ceramic heads after 9 years to reveal the in vivo wear kinetics of this common bearing combination. METHODS Fifty-seven patients (72 hips; 46.5 ± 15.5 years; range 16-76 years) who underwent hip arthroplasty with an HCLPE liner (28- or 32-mm Biolox forte ceramic head) were followed up (mean 9.1 ± 2.4 years; range 3.9-13.8 years). Conventional anteroposterior X-rays were analyzed using Hip Analysis Suite software. RESULTS Volumetric wear had a mean of 38.67 ± 22.09 mm3/year, 333.08 ± 183.93 mm3 overall, and linear wear was 0.063 ± 0.03 mm/year and 0.546 ± 0.27 mm overall. Male patients had a significantly higher wear rate (46.42 ± 27.68 mm3/year) and total wear (400.71 ± 235.21 mm3). Larger femoral heads had a significantly higher wear rate (43.10 ± 23.93 mm3/year) and total wear (364.23 ± 203.68 mm3). Regression analysis showed a significant cubic relationship (R2 = 0.307) with increasing yearly wear after approximately 108 months postoperatively. CONCLUSIONS HCLPE liners show significant in vivo wear after 9 years. While the total wear compared to ultra high molecular weight polyethylene liners was decreased, the wear kinetics show a comparable course. The increase in wear rate after only 108 months postoperatively is especially alarming. Longer term follow-up is needed to distinguish the long-term superiority of HCLPE liners in polyethylene-ceramic paired hip arthroplasty.
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Stavrakis A, Weitzler L, Wright T, Padgett DE. Less Midterm Damage and Oxidation Are Seen in Retrieved Highly Crosslinked Ultrahigh-Molecular-Weight Polyethylene Tibial Inserts than in Direct Compression Molded Polyethylene Inserts. HSS J 2018; 14:159-165. [PMID: 29983658 PMCID: PMC6031546 DOI: 10.1007/s11420-018-9608-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Highly crosslinked ultrahigh-molecular-weight polyethylene (XLPE) shows reduced wear in total hip arthroplasty compared to direct compression-molded polyethylene (compPE); however, minimal research evaluating polyethylene damage in XLPE tibial inserts in total knee arthroplasty exists. QUESTIONS/PURPOSES We evaluated damage and material properties in retrieved XLPE components at midterm (≥ 2.5 years) follow-up. METHODS We identified 19 XLPE tibial inserts with ≥ 30 months in vivo using our institutional review board-approved implant retrieval system; 19 compPE retrieved inserts were matched based on age at index surgery, body mass index, sex, and length of implantation. Articular surface damage was assessed using a subjective grading system. Swell ratio testing and Fourier-transform infrared spectroscopy were used to measure crosslink density (XLPE) and oxidation (XLPE, compPE), respectively, at loaded and unloaded surface and subsurface regions. RESULTS CompPE inserts had higher overall damage than XLPE inserts, specifically at the post of posterior-stabilized inserts. The XLPE inserts had lower crosslink density at the loaded surface (0.159 mol/dm3) than either unloaded region (0.183 mol/dm3). CompPE peak oxidation index (OI) was greater than XLPE peak OI in the loaded and unloaded surface regions (1.67 vs. 0.61 and 1.38 vs. 0.46, respectively). CONCLUSIONS Surface damage and oxidation are reduced in XLPE inserts compared to compPE at midterm follow-up. Peak OI greater than 1.0 in the compPE group suggests that mechanical-property degradation had occurred, a likely cause for increased damage. Longer-term retrievals will determine whether these trends continue. Based on midterm results, XLPE shows an advantage over compression molded PE in total knee arthroplasty.
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Affiliation(s)
| | - Lydia Weitzler
- Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Timothy Wright
- Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
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