Early failure of a modern moderately cross-linked polyethylene acetabular liner

Abstract

Modern polyethylene components for total hip arthroplasty have shown excellent long-term wear properties. However, among 204 primary total hip arthroplasty procedures performed by one surgeon using the Exactech Connexion GXL Liner, we identified 5 cases of severe polyethylene wear and osteolysis which occurred within 5 years of the index surgery. Among the 5 cases, all patients had a size 36 head with an acetabular component from size 52 to 56 mm. All patients had a UCLA activity scale score of at least 6 at the time that the osteolysis was detected. The average wear rate was 0.265 mm ± 0.207 mm per year. This review of 5 cases of catastrophic early polyethylene wear demonstrates a concerning trend with the use of the Exactech Connexion GXL liner. Further investigation is warranted to evaluate material characteristics which may have caused this accelerated wear and to prevent recurrences of this complication in the future.

Recent update on crosslinked polyethylene in total hip arthroplasty

“…the "polar-locking" mechanism that is combined with antirotational tabs. Kahlenberg et al [50] identified five cases (among 204 primary THA) of severe polyethylene wear (0.265 mm/year rate) and osteolysis which occurred within 5 years of the index surgery using this specific PE. Ceramic heads with 36-mm diameter were used in all the cases.…”

A novel method of fabricating multi‐material acetabular liner using fused filament fabrication

“…Charnley used Poly Tetra Fluro Ethylene (PTFE) material due to its inertness, high thermal stability, and hydrophobic properties but observed higher wear rate, which was referred by McKee 4 . Attempts were made in using Polyethylene (PE), 5 cross‐linked polyethylene (XLPE), 6 Ultra‐High Molecular Weight Polyethylene (UHMWPE), 7 and High‐Density Polyethylene (HDPE) 8 with ceramic particles as liner material in order to counter the drawbacks encountered in PTFE liner 9,10 . Biocomposites were also used to resolve the problems of wear in polyethylene liners 11 …”

Catastrophic Early Failure and Fragmentation of a Modern Moderately Cross-linked Polyethylene Acetabular Liner

“…Meanwhile, a more recent randomized controlled trial with 10-year follow-up demonstrated that cross-linked polyethylene liners have significantly reduced wear and revision rates compared to conventional polyethylene [ 7 ]. Despite these potential benefits, there have been a few reports of early failures of cross-linked polyethylene acetabular liners, potentially due to differences in mechanical properties compared to conventional liners [ [8] , [9] , [10] , [11] ].…”