Large Femoral Heads in Total Hip Arthroplasty With Vitamin E Highly Cross-Linked Polyethylene: Head Penetration Rates Compared to Highly Cross-Linked Polyethylene

Nielson, Trent; Owens, Garrett; Miller, Brandon; Meneghini, Ethan; Deckard, Evan R.; Meneghini, R. Michael

doi:10.1016/j.arth.2022.01.075

Cited by 11 publications

(5 citation statements)

References 43 publications

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“…HXLPE liners with vitamin E do not show statistically significant lower wear rates, even when combined with the largest possible head. 30,31 Together, all studies reporting excellent wear rates with thin liners contradict an earlier in vitro report by Johnson et al, 10 which found higher wear rates in thinner HXLPE liners compared to thicker HXLPE liners.…”

Section: Discussionmentioning

confidence: 83%

Thin highly cross-linked polyethylene liners combined with large femoral heads in primary total hip arthroplasty show excellent survival and low wear rates at a mean follow-up of 12.8 years

Fransen

Bengoa

Neufeld

et al. 2023

The Bone & Joint Journal

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Aims Several short- and mid-term studies have shown minimal liner wear of highly cross-linked polyethylene (HXLPE) in total hip arthroplasty (THA), but the safety of using thinner HXLPE liners to maximize femoral head size remains uncertain. The objective of this study was to analyze clinical survival and radiological wear rates of patients with HXLPE liners, a 36 mm femoral head, and a small acetabular component with a minimum of ten years’ follow-up. Methods We retrospectively identified 55 patients who underwent primary THA performed at a single centre, using HXLPE liners with 36 mm cobalt-chrome heads in acetabular components with an outer diameter of 52 mm or smaller. Patient demographic details, implant details, death, and all-cause revisions were recorded. Cox regression and Kaplan-Meier survival was used to determine all-cause and liner-specific revision. Of these 55 patients, 22 had a minimum radiological follow-up of seven years and were assessed radiologically for linear and volumetric wear. Results Overall survival rate for all-cause revision was 94.5% (95% confidence interval (CI) 81.7% to 97.2%) at a mean follow-up of 12.8 years (10.9 to 18.7). Three patients were revised, none for liner wear, fracture, or dissociation. A total of 22 patients were included in the radiological analysis (mean follow-up 9.9 years (7.5 to 13.7)). Mean linear liner wear was 0.085 mm (95% CI -0.086 to 0.257) and the volumetric wear rate was 11.097 mm3/year (95% CI -6.5 to 28.7). Conclusion Using HXLPE liners with 36 mm heads in 52 mm acetabular components or smaller is safe, with excellent survival and low rates of linear and volumetric wear at medium-term follow-up. Patients did not require revision surgery for liner complications such as fracture, dissociation, or wear. Our results suggest that the advantages of using larger heads outweigh the potential risks of using thin HXLPE liners. Cite this article: Bone Joint J 2023;105-B(1):29–34.

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Section: Discussionmentioning

confidence: 83%

Thin highly cross-linked polyethylene liners combined with large femoral heads in primary total hip arthroplasty show excellent survival and low wear rates at a mean follow-up of 12.8 years

Fransen

Bengoa

Neufeld

et al. 2023

The Bone & Joint Journal

View full text Add to dashboard Cite

show abstract

“…However, there are few studies on the safety of using a large femoral head on a thin PE liner, and this study provides signi cant evidence for the consideration of this option. Although several studies have demonstrated that there is no signi cant difference in femoral head penetration between conventional HXLPE and VEPE 28,29 , to the best of our knowledge, no study has compared their use with thin PE liners when considering the use of large femoral heads. In addition, unlike previous studies, the possibility of PE liner fractures in both groups was demonstrated in the present study.…”

Section: Discussionmentioning

confidence: 94%

Safety of Using a Large Femoral Head on Thin Polyethylene for Total Hip Arthroplasty Based on Different Types of Polyethylene

Do,

Moon,

Suh

et al. 2023

Preprint

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The use of a large femoral head in total hip arthroplasty (THA) to stabilize and reduce the incidence of dislocation is on the increase, but concerns arise when combining them with small acetabular components due to potential mechanical failures in thin polyethylene (PE) liners. A single-institution, retrospective cohort study was conducted on 116 patients with minimum 2-year follow-up who received 36-mm femoral heads and acetabular components ≤52 mm, using either remelted highly cross-linked polyethylene (remelted HXLPE) or vitamin E-infused HXLPE (VEPE). Osteolysis and implant loosening were not observed in either group. Although fractures of the PE liner were observed in two cases (1.7%), the clinical outcomes were excellent, as the mean modified Harris Hip Score (mHHS) at the last follow-up was 93.5. Moreover, the mean linear wear rates in both groups were low, with 0.035 mm/y in remelted HXLPE and 0.030 mm/y in VEPE. In conclusion, The use of a large femoral head on a thin PE liner can be a good treatment option in patients who need to prioritize stability; however, careful attention should be paid to mechanical fractures of the PE liner.

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“…However, there are few studies on the safety of using a large femoral head on a thin PE liner, and this study provides significant evidence for the consideration of this option. Although several studies have demonstrated that there is no significant difference in femoral head penetration between conventional HXLPE and VEPE 29 , 30 , to the best of our knowledge, no study has compared their use with thin PE liners when considering the use of large femoral heads. In addition, unlike previous studies, the possibility of PE liner fractures in both groups was demonstrated in the present study.…”

Section: Discussionmentioning

confidence: 95%

Safety of using a large femoral head on thin polyethylene for total hip arthroplasty based on different types of polyethylene

Do,

Moon,

Suh

et al. 2023

Sci Rep

View full text Add to dashboard Cite

The use of a large femoral head in total hip arthroplasty (THA) to stabilize and reduce the incidence of dislocation is on the increase, but concerns arise when combining them with small acetabular components due to potential mechanical failures in thin polyethylene (PE) liners. A single-institution, retrospective cohort study was conducted on 116 patients with minimum 2-year follow-up who received 36-mm femoral heads and acetabular components ≤ 52 mm, using either remelted highly cross-linked polyethylene (remelted HXLPE) or vitamin E-infused HXLPE (VEPE). Osteolysis and implant loosening were not observed in either group. Although a fracture of the PE liner was observed in each group (1.7%), the clinical outcomes were excellent, as the mean modified Harris Hip Score (mHHS) at the last follow-up was 93.5. Moreover, the mean linear wear rates measured by digital imaging software in both groups were low, with 0.035 mm/y in remelted HXLPE and 0.030 mm/y in VEPE. In conclusion, The use of a large femoral head on a thin PE liner can be a viable treatment option in patients who need to prioritize stability; however, careful attention should be paid to mechanical fractures of the PE liner.

show abstract

Large Femoral Heads in Total Hip Arthroplasty With Vitamin E Highly Cross-Linked Polyethylene: Head Penetration Rates Compared to Highly Cross-Linked Polyethylene

Cited by 11 publications

References 43 publications

Thin highly cross-linked polyethylene liners combined with large femoral heads in primary total hip arthroplasty show excellent survival and low wear rates at a mean follow-up of 12.8 years

Thin highly cross-linked polyethylene liners combined with large femoral heads in primary total hip arthroplasty show excellent survival and low wear rates at a mean follow-up of 12.8 years

Safety of Using a Large Femoral Head on Thin Polyethylene for Total Hip Arthroplasty Based on Different Types of Polyethylene

Safety of using a large femoral head on thin polyethylene for total hip arthroplasty based on different types of polyethylene

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