Implant survival of 2,723 vitamin E-infused highly crosslinked polyethylene liners in total hip arthroplasty: data from the Finnish Arthroplasty Register

Abstract

Background and purpose — The use of crosslinked polyethylene in total hip arthroplasty (THA) has decreased wear remarkably. It has been suggested that the antioxidative effects of vitamin E may enhance the wear properties of polyethylene even further. This study evaluates revision rates between vitamin E-infused polyethylene liners (E1 and E-poly, ZimmerBiomet, Warsaw, IN, USA) versus moderately crosslinked polyethylene (ModXLPE) liners from the same manufacturer used in primary THA. Patients and methods — We conducted a study based on data from the Finnish Arthroplasty Register. The study group consisted of 2,723 THAs with a vitamin E-infused liner and a reference group of 2,707 THAs with a moderately crosslinked polyethylene liner. Survivorship, revision risk, and re-revision causes were compared between groups. Results — The 7-year survival of the vitamin E-infused polyethylene liner group and of the reference group with revision for any reason as the endpoint was comparable (94% [95% CI 92.9–94.9] and 93% [CI 91.9–93.9], respectively). The adjusted hazard ratio (HR) for any revision was similar between the groups (0.7 [CI 0.4–1.1]). When revision for aseptic loosening was studied as the endpoint, the survival for the study group was 99% (CI 98.6–99.4) and for the reference group 99% (CI 98.7–99.5), and the risk of revision was comparable between the study groups (HR 1.3 [CI 0.7–2.5]). Interpretation — After an observation period of 7 years vitamin E-infused liners shows results equal to results obtained with crosslinked polyethylene liners.

Vitamin E-Enhanced Liners in Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

“…Study bias was low in these RCTs [22][23][24]26]. In the quality assessment of OSs using the Newcastle-Ottawa Scale, the scores for the studies conducted by Sillesen et al [28], Galea et al [18], and Hemmilä et al [29] were 6, 8, and 5, respectively. Among the 14 included studies, most of the articles used Roentgen Stereogrammetric Analysis (RSA) imaging software to measure the wear.…”

“…From the remaining 56 studies, the reviewers excluded abstracts, reviews, protocols, and animal studies based on the inclusion and exclusion criteria. Finally, 14 studies were included, containing 11 RCTs and 3 case-control studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The flowchart is shown in Figure 1.…”

“…Study bias was low in these RCTs [ 22 – 24 , 26 ]. In the quality assessment of OSs using the Newcastle-Ottawa Scale, the scores for the studies conducted by Sillesen et al [ 28 ], Galea et al [ 18 ], and Hemmilä et al [ 29 ] were 6, 8, and 5, respectively.…”

“…Nine of the 14 studies reported revision rates caused by varied reasons. In particularly, Hemmilä et al [ 29 ] collected data from multiple medical centers for comparison. The revision rates were not reported in the remaining studies because the follow-up time was short or because of surgical success.…”

“…Among the included studies, Busch et al [ 21 ] used computer-assisted design software to process images, Van Erp et al [ 22 ] used PACS View Pro-X, and Galea et al [ 17 ] and Sillesen et al [ 28 ] used Martell Hip Analysis Suite software. The study of Hemmilä et al [ 29 ] mainly focused on the revision and survival rate of the prosthesis, and there was no specific report on image processing methods. All other studies used RSA.…”