Abstract
Highly cross-linked polyethylene has been associated with low in vitro wear, but also has decreased in vitro ultimate yield strength. We therefore asked whether highly cross-linked polyethylene would result in lower outcome scores, wear, or early failure in a young patient population. Seventy THAs in 64 patients were performed using a highly cross-linked (electron beam-irradiated to 9 Mrads) acetabular liner and a cobalt-chrome femoral head. The average age of the patients at surgery was 41 years (range, 19–50 years). The minimum followup was 2.4 years (average, 4 years; range, 2.4–6.5 years). We recorded demographic and clinical data, including Harris hip score. Polyethylene wear measurements were analyzed with a validated, computer-assisted, edge detection method. The average Harris hip score improved from 53 to 92 at last followup. There was no evidence of acetabular or femoral loss of fixation, subsidence, or loosening. Linear wear was undetectable at this followup interval. No patient experienced catastrophic failure or underwent revision surgery. These data show low polyethylene wear rates and no catastrophic failures at early followup in a young patient cohort.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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References
Berger RA, Jacobs JJ, Quigley LR, Rosenberg AG, Galante JO. Primary cementless acetabular reconstruction in patients younger than 50 years old. 7- to 11-year results. Clin Orthop Relat Res. 1997;344:216–226.
Bradford L, Baker DA, Graham J, Chawan A, Ries MD, Pruitt LA. Wear and surface cracking in early retrieved highly cross-linked polyethylene acetabular liners. J Bone Joint Surg Am. 2004;86:1271–1282.
Bradford L, Kurland R, Sankaran M, Kim H, Pruitt LA, Ries MD. Early failure due to osteolysis associated with contemporary highly cross-linked ultra-high molecular weight polyethylene: a case report. J Bone Joint Surg Am. 2004;86:1051–1056.
Bragdon CR, Kwon YM, Geller JA, Greene ME, Freiberg AA, Harris WH, Malchau H. Minimum 6-year followup of highly cross-linked polyethylene in THA. Clin Orthop Relat Res. 2007;465:122–127.
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632.
Cates HE, Faris PM, Keating EM, Ritter MA. Polyethylene wear in cemented metal-backed acetabular cups. J Bone Joint Surg Br. 1993;75:249–253.
Clohisy JC, Calvert G, Tull F, McDonald D, Maloney WJ. Reasons for revision hip surgery: a retrospective review. Clin Orthop Relat Res. 2004;429:188–192.
Clohisy JC, Harris WH. The Harris-Galante porous-coated acetabular component with screw fixation: an average ten-year follow-up study. J Bone Joint Surg Am. 1999;81:66–73.
Clohisy JC, Keeney JA, Schoenecker PL. Preliminary assessment and treatment guidelines for hip disorders in young adults. Clin Orthop Relat Res. 2005;441:168–179.
D′Antonio JA, Manley MT, Capello WN, Bierbaum BE, Ramakrishnan R, Naughton M, Sutton K. Five-year experience with Crossfire highly cross-linked polyethylene. Clin Orthop Relat Res. 2005;441:143–150.
DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.
Digas G, Karrholm J, Thanner J, Malchau H, Herberts P. Highly cross-linked polyethylene in cemented THA: randomized study of 61 hips. Clin Orthop Relat Res. 2003;417:126–138.
Dorr LD, Wan Z, Shahrdar C, Sirianni L, Boutary M, Yun A. Clinical performance of a Durasul highly cross-linked polyethylene acetabular liner for total hip arthroplasty at five years. J Bone Joint Surg Am. 2005;87:1816–1821.
Dowd JE, Sychterz CJ, Young AM, Engh CA. Characterization of long-term femoral-head-penetration rates: association with and prediction of osteolysis. J Bone Joint Surg Am. 2000;82:1102–1107.
Dowdy PA, Rorabeck CH, Bourne RB. Uncemented total hip arthroplasty in patients 50 years of age or younger. J Arthroplasty. 1997;12:853–862.
Dunkley AB, Eldridge JD, Lee MB, Smith EJ, Learmonth ID. Cementless acetabular replacement in the young: a 5- to 10-year prospective study. Clin Orthop Relat Res. 2000;376:149–155.
Endo M, Tipper JL, Barton DC, Stone MH, Ingham E, Fisher J. Comparison of wear, wear debris and functional biological activity of moderately crosslinked and non-crosslinked polyethylenes in hip prostheses. Proc Inst Mech Eng [H]. 2002;216:111–122.
Engh CA Jr, Culpepper WJ 2nd, Engh CA. Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg Am. 1997;79:177–184.
Engh CA Jr, Stepniewski AS, Ginn SD, Beykirch SE, Sychterz-Terefenko CJ, Hopper RH Jr, Engh CA. A randomized prospective evaluation of outcomes after total hip arthroplasty using cross-linked marathon and non-cross-linked Enduron polyethylene liners. J Arthroplasty. 2006;21(suppl 2):17–25.
Griffith MJ, Seidenstein MK, Williams D, Charnley J. Socket wear in Charnley low friction arthroplasty of the hip. Clin Orthop Relat Res. 1978;137:37–47.
Gruen TA, McNeice GM, Amstutz HC. ‘Modes of failure’ of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.
Heisel C, Silva M, dela Rosa MA, Schmalzried TP. Short-term in vivo wear of cross-linked polyethylene. J Bone Joint Surg Am. 2004;86:748–751.
Hui AJ, McCalden RW, Martell JM, MacDonald SJ, Bourne RB, Rorabeck CH. Validation of two and three-dimensional radiographic techniques for measuring polyethylene wear after total hip arthroplasty. J Bone Joint Surg Am. 2003;85:505–511.
Kim YH, Kim JS, Cho SH. Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series. J Arthroplasty. 1999;14:538–548.
Kim YH, Kook HK, Kim JS. Total hip replacement with a cementless acetabular component and a cemented femoral component in patients younger than fifty years of age. J Bone Joint Surg Am. 2002;84:770–774.
Maloney WJ, Galante JO, Anderson M, Goldberg V, Harris WH, Jacobs J, Kraay M, Lachiewicz P, Rubash HE, Schutzer S, Woolson ST. Fixation, polyethylene wear, and pelvic osteolysis in primary total hip replacement. Clin Orthop Relat Res. 1999;369:157–164.
Martell JM, Berdia S. Determination of polyethylene wear in total hip replacements with use of digital radiographs. J Bone Joint Surg Am. 1997;79:1635–1641.
Martell JM, Verner JJ, Incavo SJ. Clinical performance of a highly cross-linked polyethylene at two years in total hip arthroplasty: a randomized prospective trial. J Arthroplasty. 2003;18(suppl 1):55–59.
McKellop H, Shen FW, Lu B, Campbell P, Salovey R. Development of an extremely wear-resistant ultra high molecular weight polyethylene for total hip replacements. J Orthop Res. 1999;17:157–167.
McKellop H, Shen FW, Lu B, Campbell P, Salovey R. Effect of sterilization method and other modifications on the wear resistance of acetabular cups made of ultra-high molecular weight polyethylene: a hip-simulator study. J Bone Joint Surg Am. 2000;82:1708–1725.
Nashed RS, Becker DA, Gustilo RB. Are cementless acetabular components the cause of excess wear and osteolysis in total hip arthroplasty? Clin Orthop Relat Res. 1995;317:19–28.
Ostendorf M, van Stel HF, Buskens E, Schrijvers AJ, Marting LN, Verbout AJ, Dhert WJ. Patient-reported outcome in total hip replacement: a comparison of five instruments of health status. J Bone Joint Surg Br. 2004;86:801–808.
Perez RE, Rodriguez JA, Deshmukh RG, Ranawat CS. Polyethylene wear and periprosthetic osteolysis in metal-backed acetabular components with cylindrical liners. J Arthroplasty. 1998;13:1–7.
Rimnac C, Pruitt L. How do material properties influence wear and fracture mechanisms? J Am Acad Orthop Surg. 2008;16(suppl 1):S94–S100.
Russotti GM, Harris WH. Proximal placement of the acetabular component in total hip arthroplasty: a long-term follow-up study. J Bone Joint Surg Am. 1991;73:587–592.
Schmalzried TP, Guttmann D, Grecula M, Amstutz HC. The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis. J Bone Joint Surg Am. 1994;76:677–688.
Schmalzried TP, Kwong LM, Jasty M, Sedlacek RC, Haire TC, O′Connor DO, Bragdon CR, Kabo JM, Malcolm AJ, Harris WH. The mechanism of loosening of cemented acetabular components in total hip arthroplasty: analysis of specimens retrieved at autopsy. Clin Orthop Relat Res. 1992;274:60–78.
Schmalzried TP, Szuszczewicz ES, Northfield MR, Akizuki KH, Frankel RE, Belcher G, Amstutz HC. Quantitative assessment of walking activity after total hip or knee replacement. J Bone Joint Surg Am. 1998;80:54–59.
Shih CH, Lee PC, Chen JH, Tai CL, Chen LF, Wu JS, Chang WH. Measurement of polyethylene wear in cementless total hip arthroplasty. J Bone Joint Surg Br. 1997;79:361–365.
Soderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop Relat Res. 2001;384:189–197.
Tower SS, Currier JH, Currier BH, Lyford KA, Van Citters DW, Mayor MB. Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg Am. 2007;89:2212–2217.
Triclot P, Grosjean G, El Masri F, Courpied JP, Hamadouche M. A comparison of the penetration rate of two polyethylene acetabular liners of different levels of cross-linking: a prospective randomised trial. J Bone Joint Surg Br. 2007;89:1439–1445.
Wan Z, Dorr LD. Natural history of femoral focal osteolysis with proximal ingrowth smooth stem implant. J Arthroplasty. 1996;11:718–725.
Willert HG, Bertram H, Buchhorn GH. Osteolysis in alloarthroplasty of the hip: the role of ultra-high molecular weight polyethylene wear particles. Clin Orthop Relat Res. 1990;258:95–107.
Zahiri CA, Schmalzried TP, Szuszczewicz ES, Amstutz HC. Assessing activity in joint replacement patients. J Arthroplasty. 1998;13:890–895.
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One or more of the authors (JCC) have received funding from the Curing Hip Disease Fund.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
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Shia, D.S., Clohisy, J.C., Schinsky, M.F. et al. THA with Highly Cross-linked Polyethylene in Patients 50 Years or Younger. Clin Orthop Relat Res 467, 2059–2065 (2009). https://doi.org/10.1007/s11999-008-0697-2
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DOI: https://doi.org/10.1007/s11999-008-0697-2