Which is the best bearing surface for primary total hip replacement? A New Zealand Joint Registry study

Sharplin, Paul; Wyatt, Michael; Rothwell, A.; Frampton, Chris; Hooper, G.

doi:10.5301/hipint.5000585

Cited by 22 publications

(16 citation statements)

References 34 publications

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“…Ceramic-on-HXLPE in primary THR has been shown to have the lowest all-cause revision rates in a large national joint registry study and the reduced wear evident with the use of vitamin E HXLPE may lead to further reduction in revision rates. 30 A reduction in revision rates has not been shown in this study.…”

Section: Discussioncontrasting

confidence: 54%

Does vitamin E highly-crosslinked polyethylene convey an advantage in primary total hip replacement? A systematic review and meta-analysis

et al. 2019

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Background: Vitamin E highly cross-linked polyethylene (HXLPE) was developed to reduce wear in total hip replacement (THR). This formal systematic review and meta-analysis aimed to provide independent synthesis of wear characteristics of Vitamin E treated HXLPE compared to HXPLE/UHMWPE. Secondary outcome measures were differences in revision rates and functional scores. Methods: We performed a formal systematic review as per PRISMA guidelines; literature searches were conducted on 14 November 2017 (MEDLINE, Embase on Ovid, and the Cochrane Library). We included randomised controlled trials, analyses of joint registries, and case-controlled studies of primary THR comparing cups with a vitamin E HXLPE bearing with bearing surfaces made from other types of polyethylene. Initial screening was performed by 2 independent assessors; disagreement resolved in discussion with a third reviewer. Studies were evaluated using the Cochrane risk of bias tool. Data extraction permitted meta-analysis. Results: 372 studies were identified on initial screening, 5 studies met the eligibility criteria. There was no significant heterogeneity between studies. There was variable risk of bias. At a mean of 35 (range 20–60) months, Vitamin E HXLPE had significant advantages over highly cross-linked polyethylene with regards total femoral head penetration ( p = 0.004). Given the RSA measurement errors this may not be clinically significant. There were neither significant differences in revision rates nor Harris Hip Scores ( p = 0.06). Conclusion: At a minimum of 3 years follow-up there was reduced total femoral head penetration for vitamin E HXLPE over HXLPE. This bearing surface does not, as yet, have clinically significant advantages in terms of revision rates or patient function over HXLPE.

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Section: Discussioncontrasting

confidence: 54%

Does vitamin E highly-crosslinked polyethylene convey an advantage in primary total hip replacement? A systematic review and meta-analysis

et al. 2019

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“…Compared to traditional metal heads, ceramic femoral heads have a very low revision rate. A large-scale national joint registration analysis [ 33 ] indicated that lining ceramic heads with VE-PE may further reduce the revision rate. In our analysis, it was found that the revision rate of the VE-PE group was reduced by 46% (1-0.54) compared with that of the non-VE-PE group.…”

Section: Discussionmentioning

confidence: 99%

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

Cheng

Zhang

Wen

et al. 2021

BioMed Research International

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Objective. Adding vitamin E to highly cross-linked polyethylene liners is frequently performed in clinical practice, aiming at reducing liner wear, increasing liner survival, and delaying revision surgery. This study is aimed at evaluating the revision rate, total femoral head penetration, and postoperative clinical function of highly cross-linked polyethylene liners with and without vitamin E in total hip arthroplasty. Methods. We conducted a systematic literature search to identify the use of highly cross-linked vitamin E liners compared to other liners in patients who received total hip arthroplasty (THA) before April 2021. The study quality assessment and data collection were conducted by two independent reviewers. Studies were artificially grouped, and vitamin E-enhanced liners (VE-PE) were compared with vitamin E-free liners (non-VE-PE). Analyses were executed using Review Manager version 5.4.1. Results. From the preliminary screening of 568 studies, fourteen studies met the research criteria. Compared to non-VE-PE, using VE-PE reduced the all-cause revision rate ( odds ratio = 0.54 ; 95% confidence interval (CI) 0.40, 0.73; P < 0.0001 ). The total femoral head penetration of the VE-PE was lower than that of the non-VE-PE ( mean difference = − 0.10 ; 95% CI -0.17, -0.03; P = 0.007 ). However, there was no difference in clinical function, including the Harris Hip Score and EuroQol Five-Dimension Questionnaire scores. Conclusion. Compared to the liners without vitamin E, the addition of vitamin E to liners could reduce the all-cause revision rate by approximately 46% in the short-term follow-up. In addition, even though addition of vitamin E could also slow down femoral head penetration, there is no contribution to clinical function.

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“…Bearing choice in the British group was mostly ceramic on ceramic, however in the Irish group ceramic on polyethylene was chosen by the majority of surgeons which is in line with current evidence on the least wear in bearing surfaces. [13, 14]…”

Section: Discussionmentioning

confidence: 99%

Return To Sporting Activity After Total Hip Arthroplasty - An Irish Experience

Moloney

Vukanic

Kearney

et al. 2020

Preprint

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Objective Total hip arthroplasty (THA) is traditionally an operation of the elderly. In the past few decades we have seen younger patient cohorts undergoing THA and increased activity levels in elderly cohorts. The aim of this paper is to assess attitudes and practices toward return to sport after THA in Irish surgeons performing a minimum of forty total hip replacements per annum. Design Web-based survey, level of evidence 5 Methods Current practices in the Irish orthopaedic community were assessed through a web-based survey. Of 90 consultants surveyed, 35 responded. 8 respondents did not perform greater than forty THA operations per annum and thus were excluded from the later part of the survey. Results The majority of respondents (61.54%) would use an uncemented design for a patient planning on returning to sport. 26.92% would use a hybrid design. 3.85% would opt for a resurfacing arthroplasty. The majority of surgeons (73.08%) would use an uncemented femoral implant. 92.81% would use a ceramic on polyethylene bearing surface. 57.69% of surgeons would perform a posterolateral approach and 30.77% would opt for a anterolateral approach. All respondents would allow patients to return to low impact sports such as golf, swimming and walking following THA. Significantly more variance was seen across surgeons when considering a return to medium impact and high impact sports. Summary/Conclusion This survey of some of the most eminent arthroplasty surgeons practicing in Ireland will hopefully allow for consolidation of guidelines on return to sport after THA.

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Which is the best bearing surface for primary total hip replacement? A New Zealand Joint Registry study

Abstract: CoPx remained the most durable and successful coupling used in primary THR in New Zealand irrespective of age, gender or size of femoral head.

Cited by 22 publications

References 34 publications

Does vitamin E highly-crosslinked polyethylene convey an advantage in primary total hip replacement? A systematic review and meta-analysis

Does vitamin E highly-crosslinked polyethylene convey an advantage in primary total hip replacement? A systematic review and meta-analysis

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

Return To Sporting Activity After Total Hip Arthroplasty - An Irish Experience

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