Risk of Revision Following Total Hip Arthroplasty: Metal-on-Conventional Polyethylene Compared with Metal-on-Highly Cross-Linked Polyethylene Bearing Surfaces

Abstract

Abstract:The results of randomized controlled trials and systematic reviews have suggested reduced radiographic wear in highly cross-linked polyethylene compared with conventional polyethylene in primary total hip arthroplasty. However, longer-term clinical results have not been thoroughly examined, to our knowledge. The purpose of this study was to compare the risk of revision for metal-on-conventional and metal-on-highly cross-linked total hip arthroplasty bearing surfaces with use of a distributed data network of six national and regional registries (Kaiser Permanente, HealthEast, the Emilia-Romagna region in Italy, the Catalan region in Spain, Norway, and Australia). Inclusion criteria were osteoarthritis as the primary diagnosis, cementless implant fixation, and a patient age of forty-five to sixty-four years. These criteria resulted in a sample of 16,571 primary total hip arthroplasties. Multivariate meta-analysis was performed with use of linear mixed models, with survival probability as the unit of analysis. The results of a fixed-effects model suggested that there was insufficient evidence of a difference in risk of revision between bearing surfaces (hazard ratio, 1.20 [95% confidence interval, 0.80 to 1.79]; p = 0.384). Highly cross-linked polyethylene does not appear to have a reduced risk of revision in this subgroup of total hip arthroplasty patients. Arthroplasties involving highly cross-linked polyethylene do not appear to have an increased risk of revision in this subgroup of total hip arthroplasty patients.T otal hip arthroplasty is an effective procedure with longterm survival rates of more than 85% at twenty years of follow-up 1,2 . Despite the effectiveness of this procedure, some total hip arthroplasties require revision, usually because of wear and osteolysis. These revision procedures are associated with an increased risk of complications, re-revision, and patient mortality 3,4 . In addition, the demand for revision total hip arthroplasty is projected to increase substantially through 2030 5 . As a result, technological advances in bearing surfaces have been introduced with the aim of increasing the longevity of total hip arthroplasty implants by reducing wear and associated osteolysis and loosening. Highly cross-linked polyethylene is one example of a bearingsurface advancement introduced into the market for this purpose 6 . The results of two systematic reviews and a meta-analysis have suggested that the use of highly cross-linked polyethylene is associated with a reduced risk of radiographic wear and a lower rate of femoral head penetration [6][7][8] . In addition, the authors of several small, single-center randomized controlled trials have reported lower rates of femoral head penetration and wear in highly cross-linked polyethylene compared with conventional polyethylene [9][10][11][12]

Choice of implant combinations in total hip replacement: systematic review and network meta-analysis

“…Our finding may result from a lack of data in our network meta-analysis to compare outcomes, but is in line with published evidence from six national and regional registries. 34 …”

National and International Postmarket Research and Surveillance Implementation

“…Paxton and colleagues compared metal-on-HXLPE with metal-on-conventional (non-cross-linked) polyethylene bearing surfaces and found that non-cross-linked polyethylene was not associated with significantly worse outcomes compared with metal on HXLPE (http://dx.doi.org/10.2106/JBJS.N.00460) 13 . While the estimate of the effect trended in the direction of higher revision occurrence with metal on non-cross-linked polyethylene, the difference was not significant (hazard ratio [HR], 1.20; 95% confidence interval [CI], 0.80 to 1.79).…”

Comparison of Polyethylene Wear before and after Hip Revision with Liner Exchange Fixed with the Original Locking Mechanism

“…Various of highly cross-linked polyethylene(HCLPE) liners (such as Marathon, Depuy; X3, Stryker; Longevity, Zimmer; XLPE, Smith and Nephew; and Acrom XL, Biomet) have been used extensively to decrease wear, osteolysis and related implant failures in THA. Studies[3–5] have also shown that HCLPE has much less wear and osteolysis than does CUHMWPE. But long-term result of HCLPE in revision THA is unknown.…”