Up to 18-Year Follow-Up Wear Analysis of a First-Generation Highly Cross-Linked Polyethylene in Primary Total Hip Arthroplasty

Feng, James E.; Novikov, David; Chen, Kevin; Kim, Kelvin; Bookman, Jared; Anoushiravani, Afshin A.; Hamula, Matthew; Snir, Nimrod; Schwarzkopf, Ran

doi:10.1016/j.arth.2018.06.013

Cited by 12 publications

(11 citation statements)

References 32 publications

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“…[65] A follow-up study conducted with this same cohort up to 18 years found the steadystate wear rate to remain at about 0.05 mm/year. [66] Based on our data, it appears that sequentially annealed HXLPE may not perform as well as irradiated and remelted HXLPE in vivo with respect to linear head penetration. Fukui et al with 26mm zirconia femoral heads and reported head penetration rates of mean 0.068 mm/year for conventional and 0.01 mm/year for HXLPE.…”

Section: Accepted Manuscriptmentioning

confidence: 68%

Femoral Head Penetration Rates of Second-Generation Sequentially Annealed Highly Cross-Linked Polyethylene at Minimum Five Years

Deckard

Meneghini

2019

The Journal of Arthroplasty

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Background: Highly cross-linked polyethylene (HXLPE) liners in total hip arthroplasty (THA) have demonstrated decreased wear rates, resilience to cup orientation, and reduced osteolysis compared to conventional polyethylene. Sequential irradiation and annealing below the melting temperature is unique compared to most HXLPE which is irradiated and remelted. This study purpose was to provide minimum five-year femoral head penetration rates of sequentially annealed HXLPE in primary THA. Methods: A retrospective review of a prospectively collected database identified 198 consecutive, cementless primary THAs utilizing sequentially annealed HXLPE (X3 ™ , Stryker, Mahwah, NJ). Operative technique was standardized. Radiographs were analyzed utilizing the Martell method with minimum five-year and one-year radiographs as baseline to minimize the initial bedding-in period. Results: Seventy-seven hips with minimum five-year follow-up were analyzed. Mean steadystate linear and volumetric head penetration rates were 0.095 mm/year and 76 mm 3 /year. Volumetric head penetration was significantly less for 32mm compared to 36mm (p=0.028). In addition, less head penetration was observed for ceramic 32mm heads at nearly half the rate compared to CoCr 36mm heads (p≥0.092). No correlations existed between penetration rates and age, BMI, UCLA Activity Level, polyethylene thickness, cup inclination or anteversion (p≥0.10). No radiographic osteolysis was observed. Conclusion: Surprisingly, linear head penetration rates of sequentially annealed HXLPE were nearly identical to the osteolysis threshold for conventional polyethylene and greater than reports of irradiated and remelted HXLPE. Further, this data corroborates reports that HXLPE is resilient to cup orientation and demographic variables. Longer term follow-up is recommended.

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Section: Accepted Manuscriptmentioning

confidence: 68%

Femoral Head Penetration Rates of Second-Generation Sequentially Annealed Highly Cross-Linked Polyethylene at Minimum Five Years

Deckard

Meneghini

2019

The Journal of Arthroplasty

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“…This amount of wear after a prolonged period is on par with previous studies that report the wear rates of various other HCLPE liners to be between 0.020 and 0.056 mm/year. 18,24,28,29 These studies, however, had shorter follow-up times and often used less precise methods of radiographic wear measurement. In addition, these studies analyzed liners of different manufacturers, but this is the first long-term follow-up of the XLPE liner.…”

Section: Discussionmentioning

confidence: 99%

“…The reported mean wear rate observed for HCLPE liners varies from 0.00 to 0.06 mm/year in long-term follow-up studies. [16][17][18] The aim of our study is to evaluate the linear wear rate of patients who have undergone THA using a specific HCLPE acetabular liner (Reflection XLPE, Smith & Nephew Inc.) and report the longest-to-date follow-up. Previous studies on this specific liner reported steady-state wear rates at an average of 5 years' follow-up to be 0.026 mm/year.…”

mentioning

confidence: 99%

Mid- to Long-Term Survivorship Analysis of a Second-Generation Highly Cross-Linked Polyethylene in Total Hip Arthroplasty

Yeroushalmi

Lygrisse

Sharan

et al. 2020

The Journal of Hip Surgery

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The emergence of highly cross-linked polyethylene (HCLPE) has drastically improved survivorship of implants used in total hip arthroplasty (THA), as demonstrated by midterm outcomes. However, there is limited data evaluating long-term outcomes and wear rates of these liners. Therefore, the aim of this study is to evaluate the longest-to-date follow-up of a specific second-generation HCLPE liner, the progression of wear rate, and its relation to acetabular cup positioning. A retrospective study was conducted on patients who underwent THA between January 2001 and December 2005 using a specific second-generation HCLPE liner. Annual liner wear rate (mm/year) was calculated in this group as well as acetabular positioning through abduction angle (degrees). Failures and reason for failures such as periprosthetic fracture, dislocation, and osteolysis were noted when applicable. Forty hips of 35 patients were included in this study with a clinical and radiographic follow-up of 13.4 ± 2.2 years (range: 10.0–16.7 years). Linear and volumetric wear rates were calculated to be 0.037 ± 0.020 mm/year and 22.94 ± 12.07 mm3/year, respectively. No radiographic femoral or acetabular osteolysis was observed in any of the cases. One patient required revision due to complications unrelated to the liner. No significant relationship could be established for acetabular component abduction angle and linear wear rate (p = 0.690, Spearman's rho = 0.03). Our study demonstrates comparable liner wear rates to that of other second-generation HCLPE liners in long-term follow-up. The XLPE liner continues to exhibit minimal progression of linear wear when compared with previous midterm studies and maintains a low rate of postoperative complications requiring revision THA surgery. Further studies are warranted to assess long-term wear and survivorship between this specific liner and comparable HCLPE models.

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“…HXLPE liners have been developed with improved resistance to wear and fewer wear particles generated in vitro [5,6]. Several authors have studied the durability of HXLPE bearings in hip arthroplasty and reported favorable radiographic and clinical outcomes of HXLPE bearings in primary settings [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have clearly shown that HXLPE liners in primary THA have superior in vitro [5,6] wear rates and midterm to long-term in vivo [7][8][9] wear rates. Recently, Feng et al [10] have shown excellent clinical results of cementless THAs using HXLPE liner with a mean 12.9year postoperative follow-up (range, 7-18 years), demonstrating the potential benefits of this new material in providing longevity even to revision settings. The potentially important difference at revision surgery may be the increased possibility of third-body wear.…”

Section: Introductionmentioning

confidence: 99%

High survivorship of highly cross-linked polyethylene in revision Total hip Arthroplasty: a minimum 10-year follow-up study

Lim¹,

Yeo²,

Park

et al. 2019

Arthroplasty

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Purpose: Highly cross-linked polyethylene has been introduced to decrease osteolysis secondary to polyethylene wear debris generation. However, few long-term data on revision total hip arthroplasty (THA) using highly crosslinked polyethylene liners are available. The objective of this study was to determine long-term outcomes of a highly cross-linked polyethylene liner in revision THA. Materials & methods: We evaluated 63 revision THAs performed in 63 patients using a highly cross-linked polyethylene liner between April 2000 and February 2005. Of these, nine died and four were lost to follow-up. Thus, the final study cohort consisted of 50 patients (50 hips), including 26 males and 24 females with a mean age of 53 years (range, 27-75 years). Mean follow-up was 11 years (range, 10-14 years). Results: The mean Harris hip score improved from 44 points preoperatively to 85 points at the final follow-up. No radiographic evidence of osteolysis was found in any hip. The mean rate of polyethylene liner wear was 0.029 mm/year (range, 0.003 to 0.098 mm/year). A total of 5 hips (10%) required re-revision arthroplasty, including one cup loosening, one recurrent dislocation, and three deep infections. Kaplan-Meier survivorship with an end point of re-revision for any reason was 91.1% and for aseptic cup loosening was 97.9% at 11 years. Conclusion: At a minimum of 10 years, the highly cross-linked polyethylene liners showed excellent clinical performance and implant survivorship, and were not associated with osteolysis in our patients with revision THAs.

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Up to 18-Year Follow-Up Wear Analysis of a First-Generation Highly Cross-Linked Polyethylene in Primary Total Hip Arthroplasty

Cited by 12 publications

References 32 publications

Femoral Head Penetration Rates of Second-Generation Sequentially Annealed Highly Cross-Linked Polyethylene at Minimum Five Years

Femoral Head Penetration Rates of Second-Generation Sequentially Annealed Highly Cross-Linked Polyethylene at Minimum Five Years

Mid- to Long-Term Survivorship Analysis of a Second-Generation Highly Cross-Linked Polyethylene in Total Hip Arthroplasty

High survivorship of highly cross-linked polyethylene in revision Total hip Arthroplasty: a minimum 10-year follow-up study

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