The Lawrence D. Dorr Surgical Techniques &amp; Technologies Award: Using Big Heads and Small Acetabular Components With Highly Cross-Linked Polyethylene in Total Hip Arthroplasty: Is It Safe?

Baker, Claire; Bukowski, Brandon R.; Abdel, Matthew P.; Trousdale, Robert T.

doi:10.1016/j.arth.2021.01.067

Cited by 10 publications

(9 citation statements)

References 32 publications

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“…This is similar to prior reports. Baker et al 17 found no liner mechanical failures in their series. Hagman et al 22 reported no revisions due to liner-related problems (wear, fracture, or osteolysis) at a mean follow-up of 8.5 years; however, four patients underwent revision due to aseptic loosening.…”

Section: Discussionmentioning

confidence: 77%

“…One possible explanation could be the type of HXLPE used. The study by Hagman et al 22 used an annealed HXLPE liner design, while a mix of different types was used in the study by Baker et al 17 We do not think this difference alone explains the higher revision rates, as the literature has so far not shown different wear rates between annealed and remelted HXLPE. 23 Other possible influencing factors that might explain the difference (patient characteristics like sex, age, or BMI) were also comparable between those studies and ours.…”

Section: Discussionmentioning

confidence: 98%

“…8 The literature shows that this wear pattern has changed significantly with use of HXLPE. 3 Using 36 mm heads, acetabular components of 52 mm or less and HXLPE of several brands, Baker et al 17 reported a 5.6% revision and 9.3% reoperation rates, in a large cohort of patients at a mean follow-up of four years. Hagman et al 22 used a thin second-generation HXLPE in 58 primary THAs, of which they could follow 44 at a minimum of five years.…”

Section: Discussionmentioning

confidence: 99%

“…These are similar to prior reports using liners of all sizes, with linear wear rates ranging from 0.005 to 0.075 mm/year. 5 14,17,26-28 Using a second-generation HXLPE, Gaudiani et al 14 reported no difference in wear rates of second-generation HXLPE between using metal or ceramic 32 mm or 36 mm heads, up to six years after surgery. When comparing wear according to liner size, Jauregui et al 29 compared 48 patients undergoing THA with a HXLPE liner under 4 mm to those over 5.9 mm, using a second-generation HXLPE.…”

Section: Discussionmentioning

confidence: 99%

“…In this equation, π is 3.1416, r is the radius of the femoral head size in mm and w is the linear wear rate. 14,17 If the mean linear wear value when measuring the femoral head penetration for a specific patient was a negative number (a common phenomenon in this type of study known as negative wear), 17 it was corrected in a separate set of calculations by using zero as the mean linear wear for that specific patient. A linear wear rate of > 0.1 mm/year has been reported for conventional non-HXLPE as a cut-off point, above which osteolysis significantly increases.…”

Section: Methodsmentioning

confidence: 99%

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Thin highly cross-linked polyethylene liners combined with large femoral heads in primary total hip arthroplasty show excellent survival and low wear rates at a mean follow-up of 12.8 years

Fransen

Bengoa

Neufeld

et al. 2023

The Bone & Joint Journal

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Aims Several short- and mid-term studies have shown minimal liner wear of highly cross-linked polyethylene (HXLPE) in total hip arthroplasty (THA), but the safety of using thinner HXLPE liners to maximize femoral head size remains uncertain. The objective of this study was to analyze clinical survival and radiological wear rates of patients with HXLPE liners, a 36 mm femoral head, and a small acetabular component with a minimum of ten years’ follow-up. Methods We retrospectively identified 55 patients who underwent primary THA performed at a single centre, using HXLPE liners with 36 mm cobalt-chrome heads in acetabular components with an outer diameter of 52 mm or smaller. Patient demographic details, implant details, death, and all-cause revisions were recorded. Cox regression and Kaplan-Meier survival was used to determine all-cause and liner-specific revision. Of these 55 patients, 22 had a minimum radiological follow-up of seven years and were assessed radiologically for linear and volumetric wear. Results Overall survival rate for all-cause revision was 94.5% (95% confidence interval (CI) 81.7% to 97.2%) at a mean follow-up of 12.8 years (10.9 to 18.7). Three patients were revised, none for liner wear, fracture, or dissociation. A total of 22 patients were included in the radiological analysis (mean follow-up 9.9 years (7.5 to 13.7)). Mean linear liner wear was 0.085 mm (95% CI -0.086 to 0.257) and the volumetric wear rate was 11.097 mm3/year (95% CI -6.5 to 28.7). Conclusion Using HXLPE liners with 36 mm heads in 52 mm acetabular components or smaller is safe, with excellent survival and low rates of linear and volumetric wear at medium-term follow-up. Patients did not require revision surgery for liner complications such as fracture, dissociation, or wear. Our results suggest that the advantages of using larger heads outweigh the potential risks of using thin HXLPE liners. Cite this article: Bone Joint J 2023;105-B(1):29–34.

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Section: Discussionmentioning

confidence: 77%