New polyethylenes in total hip replacement

Abstract

Between 1999 and 2001, 90 patients underwent total hip replacement using the same uncemented acetabular and femoral components with a 28 mm metallic femoral head but with prospective randomisation of the acetabular liner to either Durasul highly cross-linked polyethylene or nitrogen-sterilised Sulene polyethylene. We assessed 83 patients at a minimum follow-up of ten years. Linear penetration of the femoral head was estimated at six weeks, six and 12 months and annually thereafter, using the Dorr method, given the non-spherical shape of the acetabular component. There was no loosening of any component; only one hip in the Sulene group showed proximal femoral osteolysis. The mean penetration of the femoral head at six weeks was 0.08 mm (0.02 to 0.15) for the Durasul group and 0.16 mm (0.05 to 0.28) for the Sulene group (p = 0.001). The mean yearly linear penetration was 64.8% lower for the Durasul group at 0.05 mm/year (sd 0.035) for the Sulene group and 0.02 mm/year (sd 0.016) for the Durasul (p < 0.001). Mean linear femoral head penetration at ten years was 61% less in the Durasul than Sulene group. Highly cross-linked polyethylene gives excellent results at ten years.

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

“…However, the RSA measurements also indicated migration and rotation of the components after 7 years. Garcia-Rey et al [11] reported the minimum 10-year results of a randomized trial of uncemented hips with 42 Durasul XLPE (Zimmer) and 41 Sulene conventional polyethylene (Zimmer) liners. All femoral heads were 28 mm but fabricated of stainless steel in the Sulene group and cobalt-chrome in the Durasul group.…”

“…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]. To our knowledge, there are no studies using the measurement method described by Martell of the linear and volumetric wear of electron beam 10-kGY remelted polyethylene and the presence of osteolysis at a minimum followup of 10 years.…”

Low Wear Rates Seen in THAs With Highly Crosslinked Polyethylene at 9 to 14 Years in Patients Younger Than Age 50 Years

“…None of the patients required revision surgery or had evidence of osteolysis or loosening. The remaining 10-year followup studies include patients with a mean age greater than 50 [2,4,12,14,17,21,37].…”

“…Eighty hips had the same diameter head (28 mm) allowing us to more accurately compare the different bearing materials. The type of femoral head used was related to our sequential use of materials beginning with cobalt chrome (14), ceramic (23) followed by Oxinium (43) in the hips with 28-mm heads. Although cobalt-chrome was used early in this study, our previous experience with ceramic on polyethylene encouraged us to use it as an alternative bearing.…”

There Are No Differences in Short- to Mid-term Survivorship Among Total Hip-bearing Surface Options: A Network Meta-analysis

“…At both stages of selection, we estimated chance-adjusted agreement statistics among reviewers with a j statistic (j = 0.917 for abstract review; j = 1.000 for full-text review), and all disagreements were settled by the opinion of a third senior reviewer (GAN-M). Eleven articles [2,4,5,8,14,22,28,33,40,41,49] were deemed eligible through this process and seven studies [9,[16][17][18][19][20][21] were added following a manual search of the bibliographies of the 11 chosen articles for a final study cohort of 18 manuscripts (Fig. 1).…”