The Relationship Between Polyethylene Wear and Periprosthetic Osteolysis in Total Hip Arthroplasty at 12 Years in a Randomized Controlled Trial Cohort

Abstract

Background Polyethylene acetabular components are commonplace in hip arthroplasty. Highly cross-linked polyethylene (HXLPE) has lower wear than ultra-high molecular weight polyethylene (UHMWPE). Evidence suggests wear particles induce inflammation causing peri-prosthetic osteolysis contributing to implant loosening with wear rates of 0.05mm/yr considered safe. We aimed to compare incidence and volume of peri-acetabular osteolysis between HXLPE and UHMWPE using computed tomography (CT). Methods Initially 54 hips in 53 patients were randomized to HXLPE or UHMWPE acetabular liner. At 10 years 39 hips in 38 patients remained for radiostereometric analysis (RSA) demonstrating significantly lower wear in the HXLPE group. At 12 years 14 hips in 13 patients were lost to follow-up leaving 25 hips for CT assessment. Images were reconstructed to detect osteolysis and where identified, areas were segmented and volumised. Results Osteolysis was observed in eight patients, seven from the UHMWPE group and only one from the HXLPE group (Fisher's Exact p=0.042). There was no correlation between amount of polyethylene wear and osteolysis volume however, RSA measured wear rate in patients with osteolysis from both groups was significantly higher than overall average wear rate. Conclusion This data demonstrates lower incidence of peri-acetabular osteolysis in the HXLPE group of a small cohort. Whilst numbers are too low to estimate causation, in the context of lower wear in the HXLPE group this finding supports the hypothesis that HXLPE may not elevate osteolysis risk and hence does not suggest HXLPE wear particles are more biologically active than those generated by earlier generations of polyethylene.

Fixation, sex, and age: highest risk of revision for uncemented stems in elderly women — data from 66,995 primary total hip arthroplasties in the Norwegian Arthroplasty Register

“…Reverse hybrid and erations of uncemented implants was wear and wear-related problems (osteolysis, loosening) (Havelin et al 2000, 2002, Hallan et al 2010. There is an increasing bulk of evidence that these issues are less of a problem with modern designs (Broomfield et al 2017, Devane et al 2017). Yet another possible reason for the increased usage of uncemented THAs may be inferior results of some commonly used cemented implants (Espehaug et al 2009.…”

Targeting Anion Exchange of Osteoclast, a New Strategy for Preventing Wear Particles Induced- Osteolysis

“…Specifically, wear particles promote osteoclast differentiation and activation, which leads to bone loss around the prosthesis, accompanied by an increase in peripheral inflammatory mediators and dysfunction of osteoblasts, with the process eventually leading to PO ( Goodman and Ma, 2010 ). As the degradation of material, due to movement between the prosthetic components, is unavoidable, then preventing the activation of osteoclasts, which is the direct cause of PO, could provide a therapeutic target to prevent PO and aseptic loosening of joint prostheses ( Broomfield et al, 2017 ; Sartori et al, 2017 ).…”

Highly cross-linked versus conventional polyethylene inserts in total hip arthroplasty, a five-year Roentgen stereophotogrammetric analysis randomised controlled trial

“…Although both standard PE and REXPOL showed wear rates below this threshold in our study, the long-term wear of REXPOL is still unclear. Long-term results were reported in the study by Broomfield et al[ 20 ] using another brand of HXPLE with the same low wear rates at 12 years. Rates of 0.03 mm/year were seen in the standard PE group and 0.003 mm/year in the HXLPE group, with higher wear rates in patients with osteolysis.…”