Highly Cross-Linked Polyethylene Reduces Wear and Revision Rates in Total Hip Arthroplasty

Devane, P.; Horne, J. G.; Ashmore, Alexander; Mutimer, J; Kim, Woo-Sung; Stanley, James

doi:10.2106/jbjs.16.00878

Cited by 105 publications

(60 citation statements)

References 26 publications

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“…2). Volumetric wear is a 3-dimensional measurement of femoral head penetration using additional formulations that assume cylindrical loss along its linear path [3,17]. Manual analysis and ellipse correction were specifically selected as software settings for analysis.…”

Section: Wear Ratesmentioning

confidence: 99%

Comparing In Vivo Performance of Two Highly Cross-Linked Polyethylene Thermal Treatments: Remelting vs Annealing in Acetabular Liners

Suraci

Louati

Culliton

et al. 2019

The Journal of Arthroplasty

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Background: The introduction of highly cross-linked polyethylene (HXLPE) acetabular liners has greatly improved the wear performance of metal-on-PE bearing surfaces used in total hip arthroplasty. Changing the sterilization environment and adding thermal treatments, such as remelting or annealing, were introduced to limit on-shelf and in vivo oxidation of cross-linked liners. This study compares the wear properties of the remelted A-CLASS (MicroPort) HXLPE liner to a sequentially annealed HXLPE. Methods: This retrospective study assessed linear and volumetric wear rates using Martell Hip Analysis Suite, and clinical performance through incidences of revision surgeries. A total of 80 remelted and 53 annealed liners were included in the wear analysis. All hips were reviewed for revisions. Results: There were no significant differences in steady-state linear or volumetric wear rates for remelted and annealed liners, 0.01 (À0.07 to 0.14) vs À0.01 (À0.11 to 0.1) mm/y (P ¼ .28) and À1.03 (À30.99 to 45.43) vs À1.31 (À32.23 to 23.70) mm 3 /y (P ¼ .30), respectively. Both cohorts were below the 0.1 mm/y linear wear threshold. The wear rates for patients with femoral head sizes !36 mm were not significantly different than those with 32 and 28 mm femoral head sizes (P ¼ .60). Similarly, wear rates for patients with an excessively vertical acetabular component (>50) were not significantly different than those with standard acetabular component orientations (P ¼ .97). No hips were revised due to liner-related complications. Conclusion: The wear rates of the A-CLASS remelted HXLPE acetabular liner wear rates were comparable to those of a sequentially annealed HXLPE. Further long-term studies are required to ensure acceptable resistance to fatigue and in vivo oxidation.

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Section: Wear Ratesmentioning

confidence: 99%

Comparing In Vivo Performance of Two Highly Cross-Linked Polyethylene Thermal Treatments: Remelting vs Annealing in Acetabular Liners

Suraci

Louati

Culliton

et al. 2019

The Journal of Arthroplasty

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“…Osteolysis related to polyethylene debris is a well-documented cause of late revision total hip arthroplasty (THA) [1]. However, modern highly cross-linked polyethylene has shown favorable wear properties in THA and is associated with longer survival compared to conventional polyethylene [2].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…The wear rates of metal‐on‐cross‐linked‐polyethylene (MoXLPE) bearing couples are typically less than 11 mm 3 /million cycles (Mc) compared with metal‐on‐non‐XLPE, which have reported wear rates ranging from 10 to 51 mm 3 /Mc . Clinical trials and mid‐ to long‐term follow‐up studies of XLPE have shown significantly reduced wear, less osteolysis, and a lower risk of revision than conventional non‐XLPE . A further point to note is that the revision rates for MoXLPE appear to vary according to the size of the femoral head, with 32‐mm femoral heads showing the lowest wear for MoXLPE in the AOANJRR…”

Section: Introductionmentioning

confidence: 99%

“…14,19,20 Clinical trials and mid-to long-term follow-up studies of XLPE have shown significantly reduced wear, less osteolysis, and a lower risk of revision than conventional non-XLPE. [21][22][23][24] A further point to note is that the revision rates for MoXLPE appear to vary according to the size of the femoral head, 4,5 with 32-mm femoral heads showing the lowest wear for MoXLPE in the AOANJRR. 5 A recent retrospective observational study by Matharu et al compared adverse reaction to metal debris (ARMD) revision risk in different commonly implanted metal-on-metal (MoM) and non-MoM (MoP, ceramic-on-ceramic, and ceramic-on-polyethylene) bearing couples using data from the NJR.…”

Section: Introductionmentioning

confidence: 99%

Hip simulator testing of the taper‐trunnion junction and bearing surfaces of contemporary metal‐on‐cross‐linked‐polyethylene hip prostheses

2019

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Adverse reaction to metal debris released from the taper‐trunnion junction of modular metal‐on‐polyethylene (MoP) total hip replacements (THRs) is an issue of contemporary concern. Therefore, a hip simulator was used to investigate material loss, if any, at both the articulating and taper‐trunnion surfaces of five 32‐mm metal‐on‐cross‐linked‐polyethylene THRs for 5 million cycles (Mc) with a sixth joint serving as a dynamically loaded soak control. Commercially available cobalt–chromium–molybdenum femoral heads articulating against cross‐linked polyethylene (XLPE) acetabular liners were mounted on 12/14 titanium (Ti6Al4V) trunnions. Weight loss (mg) was measured gravimetrically and converted into volume loss (mm3) for heads, liners, and trunnions at regular intervals. Additionally, posttest volumetric wear measurements of the femoral tapers were obtained using a coordinate measuring machine (CMM). The surface roughness (Sa) of femoral tapers was measured posttest. After 5 Mc, the mean volumetric wear rate for XLPE liners was 2.74 ± 0.74 mm3/Mc. The CMM measurements confirmed material loss from the femoral taper with the mean volumetric wear rate of 0.045 ± 0.024 mm3/Mc. The Sa on the worn area of the femoral taper showed a significant increase (p < 0.001) compared with the unworn area. No other long‐term hip simulator tests have investigated wear from the taper‐trunnion junction of contemporary MoP THRs. © Crown Copyright. Journal of Biomedical Materials Research Part B: Applied Biomaterials 108B:156–166, 2020.

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Highly Cross-Linked Polyethylene Reduces Wear and Revision Rates in Total Hip Arthroplasty

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

Cited by 105 publications

References 26 publications

Comparing In Vivo Performance of Two Highly Cross-Linked Polyethylene Thermal Treatments: Remelting vs Annealing in Acetabular Liners

Comparing In Vivo Performance of Two Highly Cross-Linked Polyethylene Thermal Treatments: Remelting vs Annealing in Acetabular Liners

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

Hip simulator testing of the taper‐trunnion junction and bearing surfaces of contemporary metal‐on‐cross‐linked‐polyethylene hip prostheses

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