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

Lachiewicz, Paul F.; Heckman, Daniel S.; Soileau, Elizabeth S.; Mangla, Jimmi; Martell, John M.

doi:10.1007/s11999-009-1038-9

Cited by 150 publications

(107 citation statements)

References 32 publications

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“…The clinical studies of the wear of this XLPE with large femoral heads reported low linear wear rates at 3 to 7 years [2][3][4]7]. Our previous study using the titanium fiber-metal acetabular component and this XLPE showed low linear wear and no osteolysis at 5 to 8 years followup, but there was more volumetric wear in those hips with 36-and 40-mm femoral heads [15]. There are few studies of XLPE with 10-year followup time, but these are limited by small numbers of patients and different wear measurement techniques [1,8,11,13,25].…”

Section: Introductionmentioning

confidence: 67%

Wear and Osteolysis of Highly Crosslinked Polyethylene at 10 to 14 Years: The Effect of Femoral Head Size

Lachiewicz

Soileau

Martell

2016

Clinical Orthopaedics &Amp; Related Research

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110

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Background Highly crosslinked polyethylene (XLPE) was introduced to decrease periprosthetic osteolysis related to polyethylene wear, a major reason for revision of total hip arthroplasty. However, there are few reports of wear and osteolysis at 10 years postoperatively. Questions/purposes (1) What are the linear and volumetric wear rates of XLPE at 10 to 14 years? (2) What is the relationship among linear wear, volumetric wear, and femoral head size? (3) What proportion of hips developed osteolysis and was there a relationship between osteolysis and femoral head size or polyethylene wear?Methods We evaluated a previously reported cohort of 84 hips (72 patients) with one design of an uncemented acetabular component and one electron beam 10-kGy irradiated and remelted XLPE at a mean followup of 11 years (range, 10-14 years). The choice of femoral head size was based on several factors, including the outer diameter size of the acetabular component implanted, the perceived risk of dislocation (including the history of alcohol abuse and patient age), and liner availability from the manufacturer. The femoral head sizes used were 26 mm in 10 hips (12%), 28 mm in 31 hips (37%), 32 mm in 31 hips (37%), 36 mm in eight hips (10%), and 40 mm in four hips (5%). Measurements of linear and volumetric wear were performed in one experienced laboratory by the Martell method and analyzed using the first-to-last method. Standard radiographs, with additional Judet views, were used to detect periprosthetic osteolysis. Statistical analysis of wear and osteolysis compared with head size was performed. Results For the entire cohort, the median linear wear rate as 0.024 mm/year (95% confidence interval [CI], 0.016-0.030) and the median volumetric wear rate was 12.19 mm 3 /year (95% CI, 6.6-15.7). With the numbers available, we found no association between femoral head size and linear wear rate. However, larger femoral heads were associated with more volumetric wear; 36/40-mm femoral heads had higher volumetric wear (median 26.1; 95% CI, 11.3-47.1) than did 26-mm heads (median 3.1; 95% CI, 0.7-12.3), 28-mm heads (median 12.3; 95% CI, 3.0-19.3), and 32-mm heads (median 12.9; 95% CI, 6.6-16.8; p = 0.02). Small osteolytic lesions were noted in 12 hips (14%), but with the numbers available, there was no association with head size or volumetric wear rates. Conclusions This uncemented acetabular component and this particular XLPE had low rates of linear and volumetric wear. Small osteolytic lesions were noted at 10 to 14 years

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Section: Introductionmentioning

confidence: 67%

Wear and Osteolysis of Highly Crosslinked Polyethylene at 10 to 14 Years: The Effect of Femoral Head Size

Lachiewicz

Soileau

Martell

2016

Clinical Orthopaedics &Amp; Related Research

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110

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“…[15,35] More recent studies of 28 and 32 mm femoral heads articulating with HXPLE show a low incidence of osteolysis with less than 0.1 mm per year (62 and 80 mm 3 per year) of wear. [22,28,32] However, when discussing "wear" in regards to larger femoral heads on HXLPE, surgeons, and manufacturers should focus on decreasing volumetric wear, since laboratory analysis has shown linear wear of HXLPE is independent of head size [31]. A 4-year study [22] analyzing wear rates of HXLPE using 28, In a similar study looking at wear rates of HXLE using 26, 28, 32, 36, and 40 mm femoral heads at 5-8 years after surgery, Lachiewicz et al [28] published the median linear wear rate of all components 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).…”

Section: Resultsmentioning

confidence: 99%

“…[22,28,32] However, when discussing "wear" in regards to larger femoral heads on HXLPE, surgeons, and manufacturers should focus on decreasing volumetric wear, since laboratory analysis has shown linear wear of HXLPE is independent of head size [31]. A 4-year study [22] analyzing wear rates of HXLPE using 28, In a similar study looking at wear rates of HXLE using 26, 28, 32, 36, and 40 mm femoral heads at 5-8 years after surgery, Lachiewicz et al [28] published the median linear wear rate of all components 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). The authors 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 increased volumetric wear rate and total volumetric wear ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

Ideal Femoral Head Size in Total Hip Arthroplasty Balances Stability and Volumetric Wear

2012

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Background: Over the last several years, a trend towards increasing femoral head size in total hip arthroplasty to improve stability and impingement free range of motion has been observed. Purpose: The specific questions we sought to answer in our review were: (1) What are the potential advantages and disadvantages of metal-on-metal, ceramic-on-ceramic, and metal-on-polyethylene bearings? (2) What is effect that femoral head size has on joint kinematics? (3) What is the effect that large femoral heads have on bearing surface wear? Methods: A PubMed search and a review of 2012 Orthopaedic Research Society abstracts was performed and articles were chosen that directly answered components of the specific aims and that reported outcomes with contemporary implant designs or materials. Results: A review of the literature suggests that increasing femoral head size decreases the risk of postoperative dislocation and improves impingement free range of motion; however, volumetric wear increases with large femoral heads on polyethylene and increases corrosion of the stem in large metal-onmetal modular total hip arthroplasty (THA); however, the risk of potentially developing osteolysis or adverse reactions to metal debris respectively is still unknown. Further, the effect of large femoral heads with ceramic-on-ceramic THA is unclear, due to limited availability and published data. Conclusions: Surgeons must balance the benefits of larger head size with the increased risk of volumetric wear when determining the appropriate head size for a given patient.

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“…Hammerberg et al [58] reported a linear penetration rate after an average 3.6-year followup of 0.023 and 0.021 mm/year for 28-to 32-mm and 38-to 44-mm femoral heads on Durasul 1 liners. With a longer mean followup time of 5.7 years, Lachiewicz et al [83] reported linear penetration rates of 0.06, 0.032, 0.011, and 0.075 mm/year for 26-, 28-, 32-, and 36-to 40-mm heads, respectively, on Longevity 1 liners. An RCT by Bragdon et al [21] reported linear penetration rates of 0.020 and 0.005 mm/year for 28-and 38-mm heads, respectively, with Durasul 1 and Longevity 1 liners after a followup of 6.9 years.…”

Section: Systematic Review Of Femoral Head Penetration Studies For Hxmentioning

confidence: 99%

History and Systematic Review of Wear and Osteolysis Outcomes for First-generation Highly Crosslinked Polyethylene

Kurtz

Gawel

Patel

2011

Clinical Orthopaedics &Amp; Related Research

403

282

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Background Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and osteolysis in total joint arthroplasty. While many studies report wear and osteolysis associated with HXLPE, analytical techniques, clinical study design and followup, HXLPE formulation and implant design characteristics, and patient populations differ substantially among investigations, complicating a unified perspective. Questions/purposes Literature on first-generation HXLPE was summarized. We systematically reviewed the radiographic wear data and incidence of osteolysis for HXLPE in hip and knee arthroplasty. Methods PubMed identified 391 studies; 28 met inclusion criteria for a weighted-averages analysis of two-dimensional femoral head penetration rates. To determine the incidence of osteolysis, we estimated a pooled odds ratio using a random-effects model.Results Weighted-averages analyses of femoral head penetration rates in HXLPE liners and conventional UHMWPE liners resulted, respectively, in a mean twodimensional linear penetration rate of 0.042 mm/year based on 28 studies (n = 1503 hips) and 0.137 mm/year based on 18 studies (n = 695 hips). The pooled odds ratio for the risk of osteolysis in HXLPE versus conventional liners was 0.13 (95% confidence interval, 0.06-0.27) among studies with minimum 5-year followup. We identified two clinical studies of HXLPE in TKA, preventing systematic analysis of outcomes. Conclusions HXLPE liner studies consistently report lower femoral head penetration and an 87% lower risk of osteolysis. Reduction in femoral head penetration or osteolysis risk is not established for large-diameter ([ 32 mm) metallic femoral heads or ceramic femoral heads of any size. Few studies document the clinical performance of HXLPE in knees.

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

Cited by 150 publications

References 32 publications

Wear and Osteolysis of Highly Crosslinked Polyethylene at 10 to 14 Years: The Effect of Femoral Head Size

Wear and Osteolysis of Highly Crosslinked Polyethylene at 10 to 14 Years: The Effect of Femoral Head Size

Ideal Femoral Head Size in Total Hip Arthroplasty Balances Stability and Volumetric Wear

History and Systematic Review of Wear and Osteolysis Outcomes for First-generation Highly Crosslinked Polyethylene

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