Wear and osteolysis outcomes for highly cross-linked polyethylene in primary total hip arthroplasty compared with conventional polyethylene: a 15- to 18-year single-centre follow-up study

Abstract

Background: Although highly positive results for wear reduction of highly cross-linked polyethylene (HXLPE) have been reported around the 10-year follow-up, the long-term result related to reoperation and wear-related survival is still an issue. Therefore, this study aimed to compare the follow-up results of a single manufacture’s polyethylene liner for >15 years in terms of survival and wear rate. Methods: This retrospective cohort study included 134 primary total hip arthroplasties (THAs) who were followed up for at least 15 years. The mean age at the time of surgery was 50.7 years (conventional polyethylene [CPE] group = 22; HXLPE group = 112). Linear and volumetric wear rates of polyethylene were measured, and the reoperation rate and radiographic osteolysis were evaluated and Kaplan-Meier survival analysis was performed in both groups. Implant-related complications were also examined. Results: HXLPE group showed a significantly lower wear rate in both linear and volumetric wear. None of the hip radiographs showed evidence of loosening or osteolysis in the HXLPE group. The survival rates at 15- to 18-year follow-up were 90.9% and 95.5% in the CPE and HXLPE groups when all-cause reoperation was the endpoint, and 90.9% and 100.0% when the wear-related reoperation was the endpoint, respectively. Implant-related complications were not different between the 2 groups. Conclusions: Wear reduction and osteolysis showed a great advantage in HXLPE after a 15-year follow-up. Although the CPE and HXLPE showed excellent survival, wear and osteolysis were more frequent in the CPE; therefore, the high risk of reoperation in the future should be considered.

The use of acetabular screws in total hip arthroplasty and its influence on wear and periacetabular osteolysis in the long-term follow-up

“…The inserts examined in this study were made of conventional polyethylene. The wear rate detected in our study is comparable to the values found in other investigations [25,26]. The authors are aware that the use of crosslinked PE has significantly reduced the wear rate and osteolysis in general, regardless of the use of screws [26][27][28].…”

“…The wear rate detected in our study is comparable to the values found in other investigations [25,26]. The authors are aware that the use of crosslinked PE has significantly reduced the wear rate and osteolysis in general, regardless of the use of screws [26][27][28]. Nevertheless, based on the results achieved in the present investigation, the authors recommend that, insofar as the primary stability of the implant allows it, the use of screws be done without.…”

Recent update on crosslinked polyethylene in total hip arthroplasty

“…Osteolysis of any size was noted among 9% of the XLPE hips versus 46% of the CPE hips (P < 0.001). Similar results with melted XLPE outperforming CPE with at least 15 years of follow-up were reported by Moon et al [8]. Since plain radiographs have a sensitivity close to 40% [9], osteolysis has been specifically assessed by Fukui et al [10] with computed tomography and 3D multiplanar reconstruction images.…”

“…Except age and comorbidity, other patient demographics factors, such as gender, body weight, BMI, UCLA activity score, alcohol, or steroid intake, but also liner thickness or femoral offset, had no influence on wear rates in that study. Conversely, Moon et al [8] failed to demonstrate any statistical correlation between wear and cup position.…”

Highly Crosslinked Polyethylene Liners Have Negligible Wear at 10 Years: A Radiostereometric Analysis Study

“…The Australian registry reported a hazard ratio of using noncrosslinked polyethylene of 3.02, and this discrepancy is further exaggerated in younger patients [17]. Using plain radiographs, several clinical studies reported decreased or no lysis associated with XLPE bearings after the first decade of surgery [4,6,22,26,35]. Linear wear of XLPE determined by Martell and Berdia [33] varied between 0.014 mm/year and 0.07 mm/year in these studies [4,22,25,26,39,43], which is less than the critical threshold for osteolysis of 0.05 mm/year [20] in most studies.…”