Clinical performance of a highly cross-linked polyethylene at two years in total hip arthroplasty: a randomized prospective trial

Martell, John M.; Verner, James J.; Incavo, Stephen J.

doi:10.1016/s0883-5403(03)00341-3

Cited by 202 publications

(120 citation statements)

References 16 publications

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“…Our wear values compare well with those reported by others, with low wear rates for HCLPE liners after shortand medium-term followups (Table 2) [1,9,12,14,17,18,33,43]. However, the comparison of studies of wear reduction observed in HCLPE liners should be made with caution.…”

Section: Discussionsupporting

confidence: 90%

“…These clinically meaningful differences were calculated as follows. The mean annual wear measurements of eight HCLPE studies [1,9,12,14,17,18,33,43] (Table 2) were averaged. We presumed a meaningful difference would be the difference between this number and the mean annual wear of our control group generated from our historical cohort [21].…”

Section: Methodsmentioning

confidence: 99%

“…In vitro [35,36,42] and early (2-4 years average followup) in vivo studies [10,11,18,25,31,33,35] suggest HCLPE has improved wear resistance compared with standard noncross-linked PE. However, studies reporting on the midterm (C 5 years average followup) in vivo performance of these PE liners are scant [1,4,7,9,37].…”

Section: Introductionmentioning

confidence: 99%

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

Beksaç

Salas²,

Valle

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Highly cross-linked polyethylene (HCLPE) has been used extensively to decrease osteolysis and related implant failure in THA. We compared the wear rate of HCLPE and noncross-linked conventional PE (CPE) liners and the rate of radiographic calcar resorption and osteolysis in young patients (35-60 years of age) who underwent THA by one surgeon. Thirty-four patients (41 THAs) who received a hybrid THA using a HCLPE liner were matchpaired for age, gender, body mass index, and diagnosis with a group of patients who underwent THA with identical implants but with a CPE liner. The minimum followup was 4 years (average, 5.3; range, 4-8 years). Using the Livermore measurement technique, the averages of total wear of the HCLPE and CPE liners were 0.01 mm (range, -0.23-0.4) and 0.64 mm (range, 0-1.7), respectively. The average annual wear was less for the HCLPE than the noncross-linked PE (0.002 mm, range, -0.05-0.1 versus 0.12 mm, range, 0-0.29, respectively). Four hips in the HCLPE group and 23 in the CPE group had calcar resorption measuring averages of 2.5 mm (range, 2-3) and 7.5 mm (range, 1.8-23.8), respectively. Periprosthetic osteolysis occurred in two and eight hips in the HCLPE and CPE groups, respectively. Longer followup is needed to determine if these findings will result in improved implant survivorship.

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

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

Beksaç

Salas²,

Valle

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…The acetabular abduction and anteversion angles were measured by one observer (JMM) as a component of the polyethylene wear analysis. The mean acetabular abduction angle and acetabular anteversion determined by the Martell method were 438 (range, 24°-58°) and 22°(range, 10°-39°), respectively [25][26][27].…”

Section: Methodsmentioning

confidence: 93%

Femoral Head Size and Wear of Highly Cross-linked Polyethylene at 5 to 8 Years

Lachiewicz

Heckman²,

Soileau

et al. 2009

Clin Orthop Relat Res

150

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Wear of highly cross-linked polyethylene is reportedly independent of head size. To confirm that observation we asked in our population whether head size related to wear with one type of electron beam highly cross-linked polyethylene. Of 146 hips implanted, we evaluated complete clinical and radiographic data for 90 patients (102 hips or 70%). The minimum followup was 5 years (mean, 5.7 years; range, 5-8 years). The head size was selected intraoperatively based on the size of the acetabular component and presumed risk of dislocation. Polyethylene wear measurements were performed in one experienced laboratory using the method of Martell et al.There was no hip with pelvic or femoral osteolysis. The median linear wear rate was 0.028 mm/year (mean, 0.04 mm/year), and the median volumetric wear rate was 25.6 mm 3 /year (mean, 80.5 mm 3 /year). Median total volumetric wear was 41.0 mm 3 (mean, 98.5 mm 3 ). We found no association between femoral head size and the linear wear rate, but observed an association between larger (36-and 40-mm) head size and volumetric wear rate and total volumetric wear. Although the linear wear rate of polyethylene was not related to femoral head diameter, there was greater volumetric wear (156.6 mm 3 /year) with the 36-and 40-mm heads. Pending long-term studies of large head sizes, we advise caution in using larger femoral heads in young or active patients and in those with a low risk of dislocation.

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“…Oxidation and subsequent embrittlement of UHMWPE decrease the abrasive wear resistance and increase the wear debris associated with the polymer [9,27,28,49]. Radiation crosslinking of UHMWPE reduces wear in vitro [48,50,51,53] and in vivo [29,47] but also induces free radicals, which can cause oxidation. Postirradiation melting renders crosslinked UHMWPE oxidation-resistant by allowing these residual free radicals trapped in the crystalline regions [8,40] to recombine.…”

Section: Introductionmentioning

confidence: 99%

Vitamin E-stabilized UHMWPE for Total Joint Implants: A Review

Bracco

Oral

2011

Clinical Orthopaedics &Amp; Related Research

254

162

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Background Osteolysis due to wear of UHMWPE limits the longevity of joint arthroplasty. Oxidative degradation of UHMWPE gamma-sterilized in air increases its wear while decreasing mechanical strength. Vitamin E stabilization of UHMWPE was proposed to improve oxidation resistance while maintaining wear resistance and fatigue strength. Questions/purposes We reviewed the preclinical research on the development and testing of vitamin E-stabilized UHMWPE with the following questions in mind: (1) What is the rationale behind protecting irradiated UHMWPE against oxidation by vitamin E? (2) What are the effects of vitamin E on the microstructure, tribologic, and mechanical properties of irradiated UHMWPE? (3) Is vitamin E expected to affect the periprosthetic tissue negatively? Methods We performed searches in PubMed, Scopus, and Science Citation Index to review the development of vitamin E-stabilized UHMWPEs and their feasibility as clinical implants.Results The rationale for using vitamin E in UHMWPE was twofold: improving oxidation resistance of irradiated UHMWPEs and fatigue strength of irradiated UHMWPEs with an alternative to postirradiation melting. Vitamin E-stabilized UHMWPE showed oxidation resistance superior to that of irradiated UHMWPEs with detectable residual free radicals. It showed equivalent wear and improved mechanical strength compared to irradiated and melted UHMWPE. The biocompatibility was confirmed by simulating elution, if any, of the antioxidant from implants.Conclusions Vitamin E-stabilized UHMWPE offers a joint arthroplasty technology with good mechanical, wear, and oxidation properties. Clinical Relevance Vitamin E-stabilized, irradiated UHMWPEs were recently introduced clinically. The rationale behind using vitamin E and in vitro tests comparing its performance to older materials are of great interest for improving longevity of joint arthroplasties.

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Clinical performance of a highly cross-linked polyethylene at two years in total hip arthroplasty: a randomized prospective trial

Cited by 202 publications

References 16 publications

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

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

Femoral Head Size and Wear of Highly Cross-linked Polyethylene at 5 to 8 Years

Vitamin E-stabilized UHMWPE for Total Joint Implants: A Review

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