Femoral head penetration in Vitamin-E polyethylene liner versus conventional liners in total hip arthroplasty: systematic review and meta-analysis of randomised control trials

Abstract

Background: Debate encompasses the use of Vitamin E Polyethylene or conventional Polyethylene liner in primary hip arthroplasty. Does the Inclusion of Vitamin E in PE give adequate protection from oxidation and maintains lower rates of wear? Patients and methods: We performed this study following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies were included from any region, written in any language. We had only the randomised control trials comparing the femoral head penetration between Vitamin-E diffused highly cross-linked polyethylene (VEPE) liner and conventional liners in primary total hip arthroplasty. Results: We included 10 studies in this meta-analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio to measure the treatment effect, considering the heterogeneity. We used Random-effect models. VEPE had insignificant marginal advantages for FHP within three months post-operative. Additionally, VEPE showed significantly less FHP after two and five years. After one year, it showed significantly less FHP with the VEPE group versus the UHMWPE cohort and a non-significant difference between the VEPE and XLPE group. Conclusions: In terms of FHP, this metanalysis shows less FHP for the VEPE than conventional PE. A longer follow-up period is required to evaluate whether the oxidation protection gained by Vitamin E results in lower wear rates, less osteolysis, and aseptic loosening compared to the conventional PE in the long term.

Updates on Biomaterials Used in Total Hip Arthroplasty (THA)

“…A test group followed for 1, 2, and 3 years postoperative showed that E-blended liners have less cumulative penetration of the femoral head when compared to a conventional cup, with 0.200 mm cumulative penetration at 3 years for an HXLPE/VitE cup versus 0.317 mm for a conventional cup [ 145 ]. Elbardesy et al [ 147 ] found the absence of significant differences at 1-year follow-up but significantly less femoral hip penetration at 2- and 5-years follow-up for patients with vitamin E-blended liners when compared with conventional liners. These studies concluded that vitamin E-supplemented liners have the advantages of preventing osteolysis and implant loosening, and are a necessity for revision surgery.…”