Oxidation Prevention with Vitamin E in a HXLPE Isoelastic Monoblock Pressfit Cup: Preliminary Results

Beck, Martín; Delfosse, Daniel; Lerf, R.; Becker, Roland; French, G; Hollmann, Lutz; Knahr, K.; Helmy, Naeder; Meijer, Eric; Rehbein, Philipp; Baines, J.; Steenmeijer, Vincent; Gast, Arthur de

doi:10.1007/978-3-642-27361-2_3

Cited by 8 publications

(25 citation statements)

References 17 publications

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“…54,55 Since the added vitamin E makes thermal treatment of the polymer no longer needed, the vitamin E stabilized HXLPE has improved fatigue resistance compared with conventional HXLPE. 52 Furthermore, the stabilization of HXLPE with vitamin E has been shown to protect the material from in vitro ageing, 31,55,56 and it is therefore believed to preserve its wear properties over time in the human body.…”

Section: Wear Rates Of Metal-on-polyethylene At High Cup Inclinationmentioning

confidence: 99%

Edge loading does not increase wear rates of ceramic‐on‐ceramic and metal‐on‐polyethylene articulations

et al. 2014

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The mal-positioning of total hip arthroplasty components can result in edge loading conditions. Purpose of this study was to determine if the wear rate of ceramic-on-ceramic and metal-on-polyethylene increases under edge loading conditions. The literature was reviewed to determine which of the commonly used hip bearings is the most forgiving to implant mal-orientation. Two 28-mm ceramic-on-ceramic articulations were tested in vitro: pure alumina (PAL) ceramic versus the new alumina-toughened zirconia (ATZ). Two 28-mm metal-on-polyethylene articulations were tested in vitro: conventional ultrahigh molecular weight polyethylene (UHMWPE) versus highly crosslinked polyethylene (HXLPE) stabilized with vitamin E. All bearings were tested at standard and at highest possible inclination angles. Hip simulator tests were run for five million cycles based on N = 3 tests per condition. The average wear rate of ATZ-on-ATZ is 0.024 mm(3) /Mcycles at 45° and 0.018 mm(3) /Mcycles at 65°. Wear rate of PAL-on-PAL is between 0.02 and 0.03 mm(3) /Mcycles at 45°, as well as 65°. The wear rate of UHMWPE was 31 ± 1 mm(3) /Mcycles at an inclination angle of 45° and 26 ± 1 mm(3) /Mcycles at 80°. The wear rate of vitamin E stabilized HXLPE was 5.9 ± 0.2 mm(3) /Mcycles at 45° and 5.8 ± 0.2 mm(3) /Mcycles at 80°. Edge loading does not increase the wear rate of ceramic-on-ceramic and metal-on-polyethylene articulations. The newest biomaterials showed markedly lower wear rates compared with their conventional counterparts. ATZ-on-ATZ showed the lowest wear rate of all tested pairings, but the vitamin E stabilized HXLPE seems to be the most forgiving material when it comes to implant mal-orientation.

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Section: Wear Rates Of Metal-on-polyethylene At High Cup Inclinationmentioning

confidence: 99%

Edge loading does not increase wear rates of ceramic‐on‐ceramic and metal‐on‐polyethylene articulations

et al. 2014

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“…1c). The body of the cup is made of highly-crosslinked UHMW-PE (HXLPE) stabilized with vitamin E [5,11,18].…”

Section: Methodsmentioning

confidence: 99%

“…The titanium coating was developed to maintain the natural elastic properties of isoelastic polyethylene and to promote secondary stability [8,11,18]. Primary stability is achieved by All surgeries were performed using a minimally invasive, antero-lateral approach in standardized surgical technique [26].…”

Section: Methodsmentioning

confidence: 99%

“…1c). To improve the properties, a new generation of highly cross-linked polyethylene has been developed, which is protected from oxidation by the antioxidant vitamin E [11][12][13]. This new generation of polythylene promises significantly lower wear rates [2,[11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…To improve the properties, a new generation of highly cross-linked polyethylene has been developed, which is protected from oxidation by the antioxidant vitamin E [11][12][13]. This new generation of polythylene promises significantly lower wear rates [2,[11][12][13][14]. However, previous studies have also shown that vitamin E-stabilized HXLPE has similar wear properties to HXLPE without vitamin E, but has improved fatigue strength and is protected from oxidative destruction [11,[15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: Clinical outcome and radiological analyses of migration and wear using EBRA at mid-term follow-up

Afghanyar

Joser

Tecle

et al. 2020

Preprint

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Background The newest generation of cementless titanium coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (HXLPE) has been introduced to the market in 2009. Aim of the present study was to obtain mid-term data including the analyses of migration and wear. Methods The present prospective study investigated 101 primary total hip arthroplasty (THA) cases in 96 patients at a single institution. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfication on visual analogue scale (VAS) were assessed during a mean follow-up of 79.0 months. Migration and wear were assessed using Einzel-Bild-Roentgen-Analyse (EBRA) software. Additionally, radiological alterations in the acetabular bone and complications were documented. Results At mid-term follow-up (mean 79.0 months (range: 51.8 – 101.7)), HHS was 91.1 (range 38.0 – 100.0), satisfaction on VAS was 9.6 (range 6.0 – 10.0), rest pain on VAS was 0.2 (range 0.0 – 4.0), and load pain on VAS was 0.6 (range 0.0 – 9.0). Mean migration was 0.86 mm (range: 0.0 – 2.56) after 24 months and 1.34 mm (range: 0.09 – 3.14) after 5 years. Mean annual migration rate was 0.22 (range: -0.24 – 1.34) at 5 years. Mean total wear was 0.4 mm (range: 0.03 – 1.0) at 5 years. The mean annual wear rate was 0.06 mm per year (range: 0.0 – 0.17). Radiographic analysis showed osteolysis in none of the cases and no revision surgeries had to be performed. Conclusion The concept of vitamin-E blended HXLPE in cementless isoelastic monoblock cups prevents osteolysis, aseptic loosening and the need of revision surgery at mid-term. Values for cup migration and wear stay well below the benchmarks which are considered predictive for potential future failure.

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An isoelastic monoblock cup versus a modular metal-back cup: a matched-pair analysis of clinical and radiological results using Einzel-Bild-Röntgen-Analyse software

Afghanyar,

Möller,

Wunderlich

et al. 2023

Arch Orthop Trauma Surg

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Introduction Bone preservation and long-term survival are the main challenges in cementless total hip arthroplasty (THA). A good bone stock is especially important for adequate anchorage of the cup in revision cases. However, the optimal acetabular cup design for preserving good bone stock is still unclear. We aimed to compare clinical outcome, radiological alterations, migration, and wear at mid-term for two different cup types. Materials and methods This retrospective matched-pair study was performed using the data for 98 THA cases treated with a monoblock cup composed of vitamin E-blended highly cross-linked polyethylene (VEPE; monoblock group) or a modular cup composed of a highly cross-linked polyethylene (HXLPE) without an antioxidant (modular group). Clinical results were evaluated using the Harris Hip Score (HHS). The obtained radiographs were analyzed for radiological alterations, migration, and wear using Einzel-Bild-Röntgen-Analyse (EBRA) software. Results The mean follow-up duration was 73.2 ± 19.2 months (range: 32–108 months) and 60.5 ± 12.2 months (range: 20–84 months) in the monoblock and modular groups, respectively. HHS improved to 95.7 points in the monoblock group and 97.6 points in the modular group, without significant differences (p = 0.425). EBRA measurements were obtained in all cases. Acetabular bone alterations were not detected on radiological assessments. Mean cup migration was 1.67 ± 0.92 mm (range: 0.46–3.94 mm) and 1.24 ± 0.87 mm (range: 0.22–3.62 mm) in the monoblock and modular groups. The mean wear rate was 0.21 ± 0.18 mm (range: 0.00–0.70 mm) and 0.20 ± 0.13 mm (range: 0.00–0.50 mm) in the monoblock and modular groups. Both migration and wear pattern showed no significant differences (p = 0.741 and 0.243). None of the cases required revision surgery, yielding an implant survival rate of 100% in both groups. Conclusion The isoelastic press-fit monoblock VEPE cup and modular metal-back HXLPE cup showed equivalent mid-term wear and cup migration. Long-term studies are required to determine the effects of modularity, isoelasticity, and polyethylene stabilization with vitamin E on cup loosening and survival rates.

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Oxidation Prevention with Vitamin E in a HXLPE Isoelastic Monoblock Pressfit Cup: Preliminary Results

Cited by 8 publications

References 17 publications

Edge loading does not increase wear rates of ceramic‐on‐ceramic and metal‐on‐polyethylene articulations

Edge loading does not increase wear rates of ceramic‐on‐ceramic and metal‐on‐polyethylene articulations

The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: Clinical outcome and radiological analyses of migration and wear using EBRA at mid-term follow-up

An isoelastic monoblock cup versus a modular metal-back cup: a matched-pair analysis of clinical and radiological results using Einzel-Bild-Röntgen-Analyse software

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