Large Metal Heads and Vitamin E Polyethylene Increase Frictional Torque in Total Hip Arthroplasty

Meneghini, R. Michael; Lovro, Luke R.; Wallace, Joseph M.; Ziemba-Davis, Mary

doi:10.1016/j.arth.2015.09.020

Cited by 30 publications

(14 citation statements)

References 34 publications

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“… 38 , 39 However, there was significantly more volumetric wear in 36–40 mm heads compared with smaller sizes. 39 These findings comply with both the increased frictional torque 36 and the decreased survival due to late dislocation for 36 mm MoXLPE bearings compared with CoC and CoXLPE bearings. 24 Moreover, a 13-year report on THA survival from the Australian Registry shows that THA with both bigger and smaller than 32 mm MoXLPE bearings have a greater risk of revision compared with 32 mm.…”

Section: The Benefits and Drawbacks Of Large Bearingssupporting

confidence: 66%

“…Finally, vitamin E-diffused XLPE, combined with both metal and ceramic 32 mm heads, showed a higher fictional torque compared with XLPE. 37 In long-term clinical studies no differences have been demonstrated in linear wear between 26 mm, 28 mm, 32 mm and 36 mm to 40 mm heads when MoXLPE bearings are used. 38 , 39 However, there was significantly more volumetric wear in 36–40 mm heads compared with smaller sizes.…”

Section: The Benefits and Drawbacks Of Large Bearingsmentioning

confidence: 93%

“…In vitro studies have indicated that bearing wear in XLPE and vitamin E-diffused XLPE is independent of head size up to 46 mm. 34 , 35 A more recent study 36 showed an increased frictional torque in MoXLPE bearings for head sizes 36 mm and 40 mm compared with 28 mm and 32 mm. In the same study, there was no difference in frictional torque related to head size when a CoXLPE bearing was used.…”

Section: The Benefits and Drawbacks Of Large Bearingsmentioning

confidence: 98%

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Head size in primary total hip arthroplasty

et al. 2018

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The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries.The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship.We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA.We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used.The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm.Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE).Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones.We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170061.

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Section: The Benefits and Drawbacks Of Large Bearingssupporting

confidence: 66%

Section: The Benefits and Drawbacks Of Large Bearingsmentioning

confidence: 93%

Section: The Benefits and Drawbacks Of Large Bearingsmentioning

confidence: 98%

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Head size in primary total hip arthroplasty

et al. 2018

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“…The reason may be that the addition of VE inhibits the amount of cross-linking of XLPE [ 21 , 23 ], resulting in a loss of wear resistance. Meneghini et al [ 24 ] recorded the friction torque on ceramic and CoCrMo heads when paired with XLPE liners with and without Vitamin E. With the addition of VE, the torque on the ceramic head increased by 58% and increased by 31% on the CoCrMo head. The higher torque produces greater friction, which can increase the degree of wear.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Analysis of Wearing of Hip Joint Prostheses Composed of Different Contact Materials

Wang²,

Yan³

et al. 2021

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Cobalt-chromium-molybdenum alloy (CoCrMo) and ceramic are the two most common materials for the femoral head in hip joint prostheses, and the acetabular liner is typically made from ultra-high molecular weight polyethylene (UHMWPE), highly cross-linked polyethylene (XLPE), or highly cross-linked polyethylene blended with Vitamin E (VEXLPE). The selection of suitable materials should consider both wear performance and cost-effectiveness. This study compared the wear rate between different friction pairs using a hip joint simulator and then recommended a suitable prosthesis based on the corresponding processing technology and cost. All wear simulations were performed in accordance with ISO 14242, using the same hip joint simulator and same test conditions. This study found that when using the same material for the femoral head, the XLPE and VEXLPE liners had a lower wear rate than the UHMWPE liners, and the wear rate of the XLPE liners increased after blending with Vitamin E (VEXLPE). There was no significant difference in the wear rate of XLPE when using a CoCrMo or ceramic head. Considering the wear rate and cost-effectiveness, a CoCrMo femoral head with an accompanying XLPE liner is recommended as the more suitable combination for hip prostheses.

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“…Larger femoral heads (> 36 mm) may increase the risks for other long-term complications including osteolysis, trunnionosis, and failure of acetabular osseointegration. 15,27 Some studies have expressed concern that increased utilization of larger femoral head sizes may increase the rates of volumetric wear and osteolysis over time. [28][29][30] Additional study will be necessary to confirm the safety and effectiveness of routinely using femoral head sizes 36 mm in primary THA.…”

Section: Discussionmentioning

confidence: 99%

Relative Contribution of Acetabular and Femoral Reconstruction to Prosthetic Joint Instability Risk after Primary Total Hip Arthroplasty

et al. 2019

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Prosthetic joint instability is a challenging concern for a minority of total hip arthroplasty (THA) patients. Placement of the acetabular component within the traditional safe zone does not eliminate dislocation, and the relative contribution of femoral length and offset to instability risk has not been well defined. The authors compared 53 dislocated primary THAs treated against an age- and gender-matched cohort of 134 stable primary THAs. Anteroposterior and cross-table lateral radiographs were used to determine whether reconstructions met targets for acetabular inclination (30–50 degrees), acetabular anteversion (5–30 degrees), femoral length (0–9.9 mm) and femoral offset (0–9.9 mm). Statistical analysis was performed to assess univariate and multivariate relationships with an instability event; statistical significance was set using a two-sided p-value < 0.05. Forty-seven (88.7%) of the dislocating hips had nonoptimal acetabular or femoral reconstructions. While a similar proportion of patients in the study and control groups had acetabular reconstruction within the safe zone (51.5 vs. 47.2%, p = 0.63) patients with unstable hips were more likely to have acetabular component inclination outside of the target zone (30.2 vs. 7.5%, p < 0.01), acetabular anteversion < 15 degrees (30.2 vs. 3.7%, p < 0.0001), reduced femoral length (35.9 vs. 3.7%, p < 0.0001), and reduced femoral offset (41.5 vs. 7.46%, p < 0.0001). Stepwise multivariate logistic regression was performed and identified femoral head size less than 32 mm (OR 2.9, 95% CI 1.4–6.2) and higher inclination angle (OR 1.1, 95% CI 1.04–1.2) as significant independent risk factors for hip instability. The authors' study findings suggest that insufficient acetabular anteversion, femoral length, and femoral offset reconstruction contribute significantly to instability risk following THA. Using a larger femoral head is protective, but should be balanced against long-term volumetric wear risk.

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Large Metal Heads and Vitamin E Polyethylene Increase Frictional Torque in Total Hip Arthroplasty

Cited by 30 publications

References 34 publications

Head size in primary total hip arthroplasty

Head size in primary total hip arthroplasty

In Vitro Analysis of Wearing of Hip Joint Prostheses Composed of Different Contact Materials

Relative Contribution of Acetabular and Femoral Reconstruction to Prosthetic Joint Instability Risk after Primary Total Hip Arthroplasty

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