Reduced wear in vitamin E-infused highly cross-linked polyethylene cups: 5-year results of a randomized controlled trial

Abstract

Background and purpose — Vitamin E-infused polyethylene is a relatively new material in joint arthroplasty; there are no long-term reports, and only few mid-term results. Using radiostereometric analysis (RSA), we primarily determined whether vitamin E-infused highly cross-linked polyethylene (HXLPE/VitE) acetabular cups show less wear than ultra-high molecular weight polyethylene (UHMWPE) acetabular cups at 5 years after total hip arthroplasty (THA). We also assessed whether wear rates correlate with increasing cup inclination angles or cup sizes. Patients and methods — This is a 5-year follow-up of our previously reported randomized controlled trial of 62 patients with 3 years’ follow-up, who received THA with either an HXLPE/VitE or a UHMWPE acetabular cup. At 5 years, 40 patients were analyzed (22 in the HXLPE/VitE and 18 in the UHMWPE group). Results — HXLPE/VitE cups continued to show less cumulative femoral head penetration than UHMWPE cups (HXLPE/VitE: 0.24 mm, UHMWPE: 0.45 mm; p < 0.001). Distribution of wear was also more even with HXLPE/VitE cups than with UHMWPE cups (p = 0.002). Moreover, the difference in PE wear between 1 and 5 years in both groups showed no statistically significant correlation with increasing cup inclination angles or cup sizes. Finally, no osteolysis and implant loosening occurred, and no revision surgeries were required. Interpretation — Wear rates continue to be lower in HXLPE/VitE cups than in UHMWPE cups at 5 years of follow-up without correlation with increasing cup inclination angles or cup sizes. Finally, HXLPE/VitE cups may have the potential to prevent osteolysis and implant loosening.

Vitamin E‐Enhanced Liners in Primary Total Hip Arthroplasty: A Systematic Review and Meta‐Analysis

“…From the remaining 56 studies, the reviewers excluded abstracts, reviews, protocols, and animal studies based on the inclusion and exclusion criteria. Finally, 14 studies were included, containing 11 RCTs and 3 case-control studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The flowchart is shown in Figure 1.…”

Identification of Key Candidate Genes Related to Inflammatory Osteolysis Associated with Vitamin E-Blended UHMWPE Debris of Orthopedic Implants by Integrated Bioinformatics Analysis and Experimental Confirmation

“…While total joint arthroplasty (TJA) is still the gold standard for the treatment of pain and dysfunction in patients with end-stage arthritis and femoral head necrosis, 1 , 2 determining the long-term behavior of implants remains challenging in the scientific community and healthcare service systems due to polyethylene wear, with resultant osteolysis and/or aseptic loosening. 3 Revision surgery is more difficult and costly than primary TJAs because of poorer prognosis and higher risk of failure and complications.…”

“… 3 Revision surgery is more difficult and costly than primary TJAs because of poorer prognosis and higher risk of failure and complications. 2–5 Inflammatory osteolysis initiates when macrophages recognize wear debris derived from the polyethylene (PE) liners of TJAs and release a series of cytokines and chemokines that promote the recruitment of other inflammatory cells, leading to the formation of inflamed granulomas. 4 Despite advances achieved in pharmacological therapies for inflammation in other skeletal diseases, there are no agents that specifically target periprosthetic inflammatory osteolysis.…”

“… 8 Currently, there are two methods of integrating vitamin E into UHMWPE. 2 The first is to blend vitamin E with UHMWPE resin powder: after consolidation, the blend can be irradiated for cross-linking. 5 However, the presence of vitamin E could reduce the cross-linking efficiency of UHMWPE and a concentration of vitamin E above 0.3% wt (mass fraction) in the irradiated surface would significantly impair wear characteristics.…”

“… 9 , 10 The second is doping the polyethylene polymers after radiation cross-linking in vitamin E, by which a maximum concentration of approximately 0.7 wt% can be reached on account of the saturation upper limit of the HXLPE. 2 , 5 Bichara and colleagues revealed that fabricated wear particles derived from VE-UHMWPE triggered lesser cellular responses and osteolytic potentials than conventional UHMWPE in in vivo experiments, 11 and a series of randomized controlled trials demonstrated lower wear rates in HXLPE/VitE cups than in HXLPE or UHMWPE cups in mid- or long-term follow-ups. 1 , 5 , 7 , 12 However, some investigators obtained negative results for these two materials.…”