Wear is Reduced in THA Performed with Highly Cross-linked Polyethylene

Beksaç, Burak; Salas, Antonio; Valle, Alejandro González Della; Salvati, Eduardo A.

doi:10.1007/s11999-008-0661-1

Cited by 49 publications

(33 citation statements)

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“…Crosslinked polyethylene has been developed with superior wear properties to CPE [31,32,38]. It has been suggested that the reduction in wear debris will limit osteolysis and increase the longevity of the implants [4,14,26]. In addition, oxidized zirconium femoral heads have been developed; the design rationale of this surface was the combination of ceramic wear characteristics and the mechanical properties of the metallic substrate [1,5,16,17].…”

Section: Discussionmentioning

confidence: 99%

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Oxidized Zirconium Head on Crosslinked Polyethylene Liner in Total Hip Arthroplasty: A 7- to 12-year In Vivo Comparative Wear Study

Karidakis

Karachalios

2015

Clinical Orthopaedics &Amp; Related Research

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Background Osteolysis resulting from wear debris production from the bearing surfaces is a major factor limiting long-term survival of hip implants. Oxidized zirconium head on crosslinked polyethylene (XLPE) is a modern bearing coupling. However, midterm in vivo wear data of this coupling are not known. Questions/purposes The purpose of this study was to investigate in vivo whether the combination of an oxidized zirconium femoral head on XLPE produces less wear than a ceramic head on XLPE or a ceramic head on conventional polyethylene (CPE) couplings and whether any of these bearing combinations results in higher hip scores. Methods Between 2003 and 2007, we performed 356 total hip arthroplasties in 288 patients; of those, 199 (69.1%) patients (199 hips) were enrolled in what began as a randomized trial. Unfortunately, after the 57 th patient, the randomization process was halted because of patients' preference for the oxidized zirconium bearing instead of the ceramic after (as they were informed by the consent form), and after that, alternate allocation to the study groups was performed. Hips were allocated into four groups: in Group A, a 28-mm ceramic head on CPE was used; in Group B, a 28-mm ceramic head on XLPE; in Group C, a 28-mm Oxinium head on XLPE; and in Group D, a 32-mm Oxinium head on XLPE. The authors prospectively collected in vivo wear data (linear wear, linear wear rate, volumetric wear, and volumetric wear rate) using PolyWare software. Preoperative and postoperative clinical data, including Harris and Oxford hip scores, were also collected at regular intervals. Of those patients enrolled, 188 (95%) were available for final followup at a minimum of 7 years (mean, 9 years; range, 7-12 years). Results All bearing surfaces showed a varying high bedding-in effect (plastic deformation of the liner) up to the second postoperative year. At 5 years both oxidized zirconium on XLPE groups showed lower (p \ 0.01) volumetric wear (mean ± SD mm 3 ) and volumetric wear rates (mean ± SD mm 3 /year) ( Res (2015) 473:3836-3845 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® (Group C: 356 ± 64 to 215 ± 54 mm 3 /year, Group D: 354 ± 50 to 210 ± 64 mm 3 /year) when compared with ceramic on CPE (Group A: 895 ± 131 to 380 ± 80 mm 3 /year) and ceramic on XLPE (Group B: 1625 ± 253 to 480 ± 101 mm 3 /year) groups. When wear rates of both oxidized zirconium groups were compared, no differences were found at any time interval with the numbers available. Two hips (one from Group A and one from Group B) are scheduled for revision as a result of wear and osteolysis. There were no differences in hip scores among the groups with the numbers available. Conclusions In this study, in vivo wear parameters were lower when the combination of an oxidized zirconium head on XLPE liner was used at an average of 9 years (range, 7-12 years) followup. Further larger-scale clinical studies should confirm these findings and evaluate osteolysis and revision rates...

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Section: Discussionmentioning

confidence: 99%

“…Polyethylene, moreover, has undergone many improvements, from the development of ultrahigh-molecular-weight (CPE) to crosslinked (XLPE) polyethylene. These improved polyethylenes have shown better wear characteristics in combination with mainly metallic heads in vitro [31,32,38] and in vivo [4,8,14,26,30].…”

Section: Introductionmentioning

confidence: 99%

Oxidized Zirconium Head on Crosslinked Polyethylene Liner in Total Hip Arthroplasty: A 7- to 12-year In Vivo Comparative Wear Study

Karidakis

Karachalios

2015

Clinical Orthopaedics &Amp; Related Research

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“…Based on radiograph information alone, it is impossible to distinguish between implant loosening attributable to poor osseointegration and linear osteolysis. Furthermore, most cases of radiographic osteolysis are observed only after long-term ([ 5 years) implantation as originally determined for conventional UHMWPE implants [9,22,53]. Nevertheless, the presence of wear debris and inflammation in HXLPE revision tissues, separately or in conjunction with osteoblast apoptosis, mechanical, and/or genetic factors [14,20,21,46,[50][51][52]71], may contribute to early implant loosening.…”

Section: Discussionmentioning

confidence: 95%

Do Tissues From THA Revision of Highly Crosslinked UHMWPE Liners Contain Wear Debris and Associated Inflammation?

Baxter

Freeman

Kurtz

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Polyethylene wear debris is a major contributor to inflammation and the development of implant loosening, a leading cause of THA revisions. To reduce wear debris, highly crosslinked ultrahigh-molecular-weight polyethylene (UHMWPE) was introduced to improve wear properties of bearing surfaces. As highly crosslinked UHMWPE revision tissues are only now becoming available, it is possible to examine the presence and association of wear debris with inflammation in early implant loosening. Questions/purposes We asked: (1) Does the presence of UHMWPE wear debris in THA revision tissues correlate with innate and/or adaptive immune cell numbers? (2) Does the immune cell response differ between conventional and highly crosslinked UHMWPE cohorts?Methods We collected tissue samples from revision surgery of nine conventional and nine highly crosslinked UHMWPE liners. Polarized light microscopy was used to determine 0.5-to 2-lm UHMWPE particle number/mm 2 , and immunohistochemistry was performed to determine macrophage, T cell, and neutrophil number/mm 2 . Results For the conventional cohort, correlations were observed between wear debris and the magnitude of individual patient macrophage (q = 0.70) and T cell responses (q = 0.71) and between numbers of macrophages and T cells (q = 0.77) in periprosthetic tissues. In comparison, the highly crosslinked UHMWPE cohort showed a correlation between wear debris and the magnitude of macrophage responses (q = 0.57) and between macrophage and T cell numbers (q = 0.68). Although macrophages and T cells were present in both cohorts, the highly crosslinked UHMWPE cohort had lower numbers, which may be associated with shorter implantation times. Conclusions The presence of wear debris and inflammation in highly crosslinked UHMWPE revision tissues may contribute to early implant loosening.

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“…Highly crosslinked polyethylene was introduced in an effort to decrease wear rates and reduce the risk of osteolysis and aseptic loosening secondary to polyethylene wear. 5,6,9,27,28 Previously, cobaltchrome has been reported to have increased adhesive wear compared with oxidized zirconium on ultra-high molecular weight polyethylene. 17 More recently, cobalt-chrome has demonstrated reduced wear rates using this bearing surface, and highly crosslinked polyethylene has been recommended for younger patients undergoing total hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…1,4 The introduction of highly crosslinked polyethylene has resulted in lower wear rates with at least intermediate follow-up than conventional polyethylene. [5][6][7][8][9][10][11] The improved wear rates are also maintained across various manufacturers of highly crosslinked polyethylene. However, there is a variety of femoral heads to select and pair with this improved polyethylene surface.…”

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confidence: 99%

Mid-term survivorship and clinical outcomes of cobalt-chrome and oxidized zirconium on highly crosslinked polyethylene

Petis

Vasarhelyi

Lanting

et al. 2016

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Background:The choice of bearing articulation for total hip arthroplasty in younger patients is amenable to debate. We compared mid-term patient-reported outcomes and survivorship across 2 different bearing articulations in a young patient cohort. Methods:We reviewed patients with cobalt-chrome or oxidized zirconium on highly crosslinked polyethylene who were followed prospectively between 2004 and 2012. Kaplan-Meier analysis was used to determine predicted cumulative survivorship at 5 years with all-cause and aseptic revisions as the outcome. We compared patient-reported outcomes, including the Harris hip score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short-form 12 (SF-12) scores.Results: A total of 622 patients were followed during the study period. Mean follow-up was 8.2 (range 2.0-10.6) years for cobalt-chrome and 7.8 (range 2.1-10.7) years for oxidized zirconium. Mean age was 54.9 ± 10.6 years for cobalt-chrome and 54.8 ± 10.7 years for oxidized zirconium. Implant survivorship was 96.0% (95% confidence interval [CI] 94.9%-97.1%) for cobalt-chrome and 98.7% (95% CI 98.0%-99.4%) for oxidized zirconium on highly crosslinked polyethylene for all-cause revisions, and 97.2% (95% CI 96.2%-98.2%) for cobalt-chrome and 99.0% (95% CI 98.4%-99.6%) for oxidized zirconium for aseptic revisions. An age-, sex-and diagnosis-matched comparison of the HHS, WOMAC and SF-12 scores demonstrated no significant changes in clinical outcomes across the groups. Conclusion:Both bearing surface couples demonstrated excellent mid-term survivorship and outcomes in young patient cohorts. Future analyses on wear and costs are warranted to elicit differences between the groups at long-term follow-up.Contexte : Le choix de la surface d'appui à utiliser dans une arthroplastie totale de la hanche chez de jeunes patients ne fait pas l'unanimité. Nous avons comparé les résul-tats déclarés par les patients et la survie à moyen terme associés à 2 surfaces d'appui différentes dans une cohorte de jeunes patients.Méthodes : Nous avons étudié les cas de patients ayant reçu une prothèse de chromecobalt ou de zirconium oxydé couplé au polyéthylène hautement réticulé suivis de façon prospective entre 2004 et 2012. La méthode de Kaplan-Meier a été employée pour déterminer la survie cumulative estimée après 5 ans dans les cas où le résultat est soit la reprise toutes causes confondues, soit la reprise aseptique. Nous avons comparé les résultats déclarés par les patients, notamment au moyen du score de Harris (HHS), de l'indice WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) et des scores issus de la version courte du questionnaire d'évaluation de l'état de santé général SF-12.Résultats : Au total, 622 patients ont été suivis durant la période de l'étude. En moyenne, le suivi a duré 8,2 ans (plage de 2,0 à 10,6 ans) pour le chrome-cobalt et 7,8 ans (plage de 2,1 à 10,7 ans) pour le zirconium oxydé. L'âge moyen des patients était de 54,9 ± 10,6 ans pour le chrome-cobalt et de 54,8 ± 10,7 ans pour...

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Wear is Reduced in THA Performed with Highly Cross-linked Polyethylene

Cited by 49 publications

References 46 publications

Oxidized Zirconium Head on Crosslinked Polyethylene Liner in Total Hip Arthroplasty: A 7- to 12-year In Vivo Comparative Wear Study

Oxidized Zirconium Head on Crosslinked Polyethylene Liner in Total Hip Arthroplasty: A 7- to 12-year In Vivo Comparative Wear Study

Do Tissues From THA Revision of Highly Crosslinked UHMWPE Liners Contain Wear Debris and Associated Inflammation?

Mid-term survivorship and clinical outcomes of cobalt-chrome and oxidized zirconium on highly crosslinked polyethylene

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