Wear Rates of Larger-Diameter Cross-Linked Polyethylene at 5 to 13 Years: Does Liner Thickness or Component Position Matter?

Haw, Jonathan; Battenberg, Andrew K.; Huang, Der-Chen T.; Schmalzried, Thomas P.

doi:10.1016/j.arth.2016.11.022

Cited by 26 publications

(13 citation statements)

References 43 publications

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“…12 (p ≥ 0.40). Further, a controversial topic is the argument for [54][55][56][57][58] or against [30,[59][60][61][62][63] compared head penetration rates of irradiated and remelted HXLPE (0.032mm/year) and onceannealed HXLPE (0.031 mm/year) using all 26mm CoCr heads at 8.2 years follow-up and showed equivalent head penetration rates [49] which corroborate previous studies with different femoral head sizes, materials and polyethylene thickness. [48,64] Still, Snir and colleagues found the wear rate at 10 years for this once-annealed polyethylene bearing against a 28mm…”

Section: Accepted Manuscriptsupporting

confidence: 77%

“…The steady-state linear head penetration rates of conventional polyethylene range from a mean of 0.05 to 0.20 mm/year with the majority of studies using CoCr heads and 26mm or 28mm sizes. The annealed HXLPEs also have reported substantial tribological improvements compared to conventional polyethylene in addition to a possible resilience to cup orientation with no effect of polyethylene thickness on the head penetration rates [30] which has been reported to affect head penetration for conventional polyethylene. [43,53] The series reported here of sequentially annealed HXLPE liners corroborate these resilience findings as no correlations of cup orientation and polyethylene thickness with head penetration were observed…”

Section: Discussionmentioning

confidence: 88%

“…However, there are data to support that no adverse effect on wear has been observed with acetabular component malposition with HXLPE liners. [30] Another limitation to this study was the exclusion of a large majority of cases due to loss of radiographic follow-up after surgery; however, our cohort is of comparable size to the majority of penetration/wear studies reported in the literature in addition to the exclusions and inclusions having statistically similar demographics (p ≥ 0.09). Our five-year mid-term data reveal surprising qualitative and quantitative information of femoral head penetration behavior in sequentially annealed HXLPE for two femoral head sizes (32mm and 36mm) of ceramic and CoCr femoral head materials.…”

Section: Accepted Manuscriptmentioning

confidence: 97%

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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 Manuscriptsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 88%

Section: Accepted Manuscriptmentioning

confidence: 97%

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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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“…The low penetration rates for the two HXLPE formulations found in this study are consistent with those found in other similar studies. [19][20][21][22][23][24] Femoral head size did not affect the linear femoral head penetration rates in either cohort in this study. This is similar to a review article that found several studies where linear penetration rate is independent of femoral head size.…”

Section: Discussionmentioning

confidence: 97%

Are the Wear and Osteolysis Outcomes Different between Annealed and Remelted First-Generation Highly Crosslinked Polyethylene after Long-Term Implantation?

Schachtner

MacDonald

Klein

et al. 2020

The Journal of Hip Surgery

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First-generation highly crosslinked polyethylene (HXLPE) was developed to reduce polyethylene wear debris and subsequent osteolysis. Two thermal stabilization strategies were developed, annealing and remelting, to remove free radicals remaining in the polymer. Both types of HXLPEs have demonstrated better wear resistance to conventional polyethylene in hip arthroplasty. However, few studies have directly compared the mid- to long-term clinical outcomes of first-generation HXLPEs. We sought to address the following research questions: (1) is there a difference between the revision reasons for HXLPE formulations (annealed and remelted), (2) is there a difference in oxidation between annealed and remelted HXLPEs, (3) is there a difference in the linear penetration rate of annealed and remelted HXLPEs, and (4) does the formulation of first-generation HXLPEs affect the prevalence of osteolysis? A total of 129 first-generation HXLPE acetabular liners were collected in a multicenter retrieval program. These components were implanted for 5 or more years and were fabricated from annealed or remelted HXLPE. Reasons for revision, body mass index, age, sex, and activity levels were collected from medical records. Oxidation was measured at four regions of interest: bearing surface, backside surface, locking mechanism, and rim. Liner penetration was directly measured from retrievals using a micrometer. Osteolysis was reported in the operative notes by the revising surgeon and a thorough review of the operative notes and radiographs. Revision reasons included infection, instability, pain, and loosening. The annealed liners had higher oxidation indices than remelted liners. There was no difference in linear penetration rates between cohorts. There was no difference in osteolysis prevalence between cohorts. We found remelted HXLPE to be more oxidatively stable than annealed HXLPE but did not find a significant difference in the linear penetration rates or the prevalence of osteolysis. Our findings demonstrate sustained long-term wear resistance of both cohorts of HXLPE. We did not find evidence to support a long-term clinical difference between the formulations of HXLPE.

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“…36 mm) articulations, concluded there is a trend for increasing volumetric wear with increasing bearing size. 39 Based on these findings, they concluded that continued follow-up of larger diameter XLPE bearings is needed. Finally, the model did not take into account the compromised safety of very thin-walled liners, large diameter of the articulations lead to smaller thickness of the PE liner.…”

Section: Discussionmentioning

confidence: 99%

Estimating the osteolysis-free life of a total hip prosthesis depending on the linear wear rate and head size

Elke¹,

Rieker

2018

Proc Inst Mech Eng H

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We present a model to estimate the osteolysis-free life of total hip arthroplasty, depending on linear wear rate and femoral head size. An estimate of the radiologic osteolysis threshold was calculated, which was based on volumetric wear. The osteolysis-free life of the cup was estimated from the quotient of the osteolysis threshold and volumetric wear rate, which was calculated from the linear wear rate. The impact of the direction of linear wear was determined by sensitivity analysis. From our review, we calculated a weighted mean polyethylene volume of approximately 670 mm as osteolysis threshold. Osteolysis-free life of less than 20 years was estimated for linear wear rates of 50 µm/year for head sizes of 32 mm or more, or for linear wear rates of 100 µm/year for any head size. For head sizes of 36 and 40 mm with a linear wear rate of 50 µm/year, the osteolysis-free period is estimated to be only 14.10 and 11.42 years, respectively. Sensitivity analysis showed reasonably robust results. With the aim of osteolysis-free life of more than 20 years, our study presents a viable model to determine maximum possible head size for articulations. Osteolysis-free period for 36 and 40 mm head sizes are far too low for conventional polyethylenes. As the threshold wear volume for highly crosslinked polyethylene is, as of yet, unknown, more research is warranted before our model can be generalized to XLPE.

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Wear Rates of Larger-Diameter Cross-Linked Polyethylene at 5 to 13 Years: Does Liner Thickness or Component Position Matter?

Cited by 26 publications

References 43 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

Are the Wear and Osteolysis Outcomes Different between Annealed and Remelted First-Generation Highly Crosslinked Polyethylene after Long-Term Implantation?

Estimating the osteolysis-free life of a total hip prosthesis depending on the linear wear rate and head size

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