Cross-linked versus conventional polyethylene for total knee arthroplasty: a meta-analysis

Abstract

BackgroundHighly cross-linked polyethylene (HXLPE) has been reported as an effective material for decreasing polyethylene wear and osteolysis in total knee arthroplasty (TKA). Because no single study to date has been large enough to definitively determine the benefit of HXLPE in TKA, we conducted a meta-analysis to pool the results from randomized controlled trials (RCTs) and non-RCTs to make such a determination.MethodsPotential candidate articles were identified by searching the Cochrane Library, Medline (1966-2015.10), PubMed (1966-2015.10), Embase (1980-2015.10), ScienceDirect (1985-2015.10), and other databases. “Gray studies” were identified from the included articles’ reference lists. Pooled data were analyzed using RevMan 5.1.ResultsThree RCTs and three non-RCTs were included in the meta-analysis. There were no significant differences between the groups in the total number of reoperations (P = 0.11), reoperations for prosthesis loosening (P = 0.08), radiolucent line (P = 0.20), osteolysis (P = 0.38), prosthesis loosening (P = 0.10), and mechanical failures related to the tibial polyethylene (P = 1.00). Similarly, no significant differences between the two groups were found in postoperative total knee score (P = 0.18) or functional score (P = 0.23).ConclusionsThe meta-analysis showed that compared with conventional polyethylene, HXLPE did not improve the clinical and radiographic outcomes in mid-term follow-up after TKA. Additional high-quality multicenter prospective RCTs with good design, large study populations and long-term follow-up will be necessary to further clarify the effect of HXLPE in TKA.

Comparable results between crosslinked polyethylene and conventional ultra-high molecular weight polyethylene implanted in total knee arthroplasty: systematic review and meta-analysis of randomised clinical trials

“…The superior performance, in terms of wear resistance, of HXLPE in THA has led to its use in TKA. On the contrary, previous studies [22,32,36,51] have shown that [15,57], in their meta-analyses, found no mechanical failures for both polyethylene groups, as well as in the results of the studies included in our research where, again, no mechanical failures were reported [23,25,29]. Therefore, HXLPE appears to be as safe as CPE in TKA.…”

Patellar management during total knee arthroplasty: a review

“… 92 As a result, advances in polyethylene fabrication have led to the development of highly crosslinked polyethylene, a modified form of conventional polyethylene that is irradiated and subsequently melted in order to achieve a higher crosslink density. 91 , 93 Highly crosslinked polyethylene is increasingly being used for tibial inserts; however, it has not been accepted for routine use in patellar components. 94 , 95 There is little data published on the clinical performance of highly crosslinked patellar components, and the available studies have reported inconsistent results.…”

Polyethylene in total knee arthroplasty: Where are we now?

“…53,54 Yu et al recently published a meta-analysis investigating PE function and failure rates. 55 Totally, six studies (three randomized clinical trials and three non-randomized clinical trials) were included with a follow-up period of 2-6 years (Table 3). [56][57][58][59][60]64 Outcome measures included total number of operations, reoperations for prosthesis loosening, radiolucent lines, osteolysis, prosthesis loosening, mechanical failures related to tibial PE, postoperative total knee score, and functional scores.…”

“…No significant differences were seen in any of the measured variables. 55 Similarly, other clinical studies also failed to find a significant advantage or disadvantage to using HXLPE over CPE. [61][62][63] There remains a need for longer term follow-up to evaluate more definitively the effectiveness of HXLPE.…”