Creep and Wear in Vitamin E-Infused Highly Cross-Linked Polyethylene Cups for Total Hip Arthroplasty

Rochcongar, Goulven; Buia, Geoffrey; Bourroux, Émeline; Dunet, Julien; Chapus, Valentin; Hulet, Christophe

doi:10.2106/jbjs.16.01379

Cited by 38 publications

(53 citation statements)

References 43 publications

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“…Other Level-I and II studies demonstrated significantly less wear for vitamin E-infused HXLPE compared with UHMWPE 20 , medium cross-linked polyethylene 21 , and HXLPE without vitamin E 22 at mid-term follow-up.…”

Section: Highly Cross-linked Polyethylene (Hxlpe)mentioning

confidence: 87%

What’s New in Hip Replacement

Glassman

2018

The Journal of Bone and Joint Surgery

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Section: Highly Cross-linked Polyethylene (Hxlpe)mentioning

confidence: 87%

What’s New in Hip Replacement

Glassman

2018

The Journal of Bone and Joint Surgery

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“…Wyss et al [6] found 0.09 mm per y and Lafon et al [7] found 0.07 mm per y. Rochcongar et al recently performed a prospective randomized controlled study comparing RM Pressfit cup (UHMWPE) to RM Pressfit vitamys cup (HXLPE/VitE) and confirmed that wear rates over the first three years following surgery were lower for the HXLPE blended with vitamin-E [2]. This might directly affect the need of late revision surgery.…”

Section: Discussionmentioning

confidence: 97%

“…The most challenging requirement in THA is a long implant survival. Aseptic loosening of the components is one of the most prevalent causes for revision surgery [2,3]. In the last decades, a substantial effort has been made to avoid or prolong aseptic loosening and mechanical failure of the implants, and this will remain a major challenge in the future [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…To improve the properties, a new generation of highly cross-linked polyethylene has been developed, which is protected from oxidation by the antioxidant vitamin E [11][12][13]. This new generation of polythylene promises significantly lower wear rates [2,[11][12][13][14]. However, previous studies have also shown that vitamin E-stabilized HXLPE has similar wear properties to HXLPE without vitamin E, but has improved fatigue strength and is protected from oxidative destruction [11,[15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: Clinical outcome and radiological analyses of migration and wear using EBRA at mid-term follow-up

Afghanyar

Joser

Tecle

et al. 2020

Preprint

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Background The newest generation of cementless titanium coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (HXLPE) has been introduced to the market in 2009. Aim of the present study was to obtain mid-term data including the analyses of migration and wear. Methods The present prospective study investigated 101 primary total hip arthroplasty (THA) cases in 96 patients at a single institution. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfication on visual analogue scale (VAS) were assessed during a mean follow-up of 79.0 months. Migration and wear were assessed using Einzel-Bild-Roentgen-Analyse (EBRA) software. Additionally, radiological alterations in the acetabular bone and complications were documented. Results At mid-term follow-up (mean 79.0 months (range: 51.8 – 101.7)), HHS was 91.1 (range 38.0 – 100.0), satisfaction on VAS was 9.6 (range 6.0 – 10.0), rest pain on VAS was 0.2 (range 0.0 – 4.0), and load pain on VAS was 0.6 (range 0.0 – 9.0). Mean migration was 0.86 mm (range: 0.0 – 2.56) after 24 months and 1.34 mm (range: 0.09 – 3.14) after 5 years. Mean annual migration rate was 0.22 (range: -0.24 – 1.34) at 5 years. Mean total wear was 0.4 mm (range: 0.03 – 1.0) at 5 years. The mean annual wear rate was 0.06 mm per year (range: 0.0 – 0.17). Radiographic analysis showed osteolysis in none of the cases and no revision surgeries had to be performed. Conclusion The concept of vitamin-E blended HXLPE in cementless isoelastic monoblock cups prevents osteolysis, aseptic loosening and the need of revision surgery at mid-term. Values for cup migration and wear stay well below the benchmarks which are considered predictive for potential future failure.

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“…While wear produces particles of debris, creep does not 5 . More recently, it is thought that the initial “loss” period may be even shorter and estimated to be 3 to 6 months 6 , 7 .…”

Section: Creepmentioning

confidence: 99%

Wear Rates of XLPE Nearly 50% Lower Than Previously Thought After Adjusting for Initial Creep

Khoshbin

Ward

et al. 2020

JBJS Open Access

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Background: The ideal bearing combination for total hip arthroplasty (THA) remains debatable. Highly cross-linked polyethylene (XLPE) is widely used, but long-term wear rates are not fully known, nor is how much the initial “creep,” if any, affects overall wear. Additionally, the use of oxidized zirconium (OxZir) is purported to lower polyethylene wear rates, but this has not been proven. We present the 10-year data of a cohort of patients who underwent THA. Patients were prospectively randomized to 1 of 4 bearing combinations: a conventional ultra-high molecular weight polyethylene (UHMWPE) or XLPE acetabular liner coupled with either a cobalt-chromium (CoCr) or OxZir femoral head. The aims of the study were to (1) assess the extent to which creep affected overall wear rates and (2) assess wear rates between OxZir and CoCr with polyethylene. Methods: A total of 92 hips (92 patients) between the ages of 22 and 65 years (mean, 52.2 ± 9.3 years) were randomized to 4 groups. At 10 years, 70 (76%) of the hips were available for analysis; patients who had undergone revision, had died, or were lost to follow-up were excluded from final analysis. Radiographic analysis was performed using a validated digital assessment program to determine linear, volumetric, and directional wear of the polyethylene for all 4 bearing couples. Radiographic assessments were performed immediately postoperatively, at 6 and 12 weeks, and then annually for a minimum of 10 years. Results: XLPE had significantly lower wear rates than UHMWPE. Once creep was eliminated, annual and overall wear rates were nearly 50% lower than have been previously reported. This was proportionally more important in the XLPE group than in the UHMWPE group. There was a nonsignificant trend toward a lower wear rate with OxZir heads. Conclusions: Creep plays a notably more important role than first thought. Once creep was eliminated, the overall wear rate was even lower than previously assumed. This has important implications for the overall survivorship of hip arthroplasty implants. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

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Creep and Wear in Vitamin E-Infused Highly Cross-Linked Polyethylene Cups for Total Hip Arthroplasty

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 38 publications

References 43 publications

What’s New in Hip Replacement

What’s New in Hip Replacement

The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: Clinical outcome and radiological analyses of migration and wear using EBRA at mid-term follow-up

Wear Rates of XLPE Nearly 50% Lower Than Previously Thought After Adjusting for Initial Creep

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