The Effect of Poly Sterilization on Wear, Osteolysis and Survivorship of a Press-fit Cup at 10-Year Followup
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
During the mid-1990s when our institution was using a press-fit porous-coated cup without supplemental initial fixation for primary THA, the manufacturer transitioned from gamma irradiation to gas plasma for the terminal sterilization of their polyethylene liners.
At minimum 10-year followup, we asked whether the fixation achieved by solely relying on a press-fit would be durable and how different liner sterilization methods affected radiographic wear, osteolysis, and survivorship.
Patients and Methods
We retrospectively reviewed 373 patients who underwent 398 primary THAs with a press-fit porous-coated cup between March 1995 and December 1996. Mean age at time of surgery was 61.5 ± 13.3 years and mean followup was 10.4 ± 3.7 years. We determined reasons for revision, survivorship, femoral head penetration, osteolysis, and wear-related complications.
Among 20 revisions involving any component, seven were associated with wear and osteolysis. Kaplan-Meier survivorship, using component revision for any reason as an end point, was 95.7% (95% confidence interval, 93.6%–97.9%) at 10 years. Noncrosslinked liners sterilized with gas plasma demonstrated a mean head penetration rate of 0.20 ± 0.09 mm/year compared with 0.13 ± 0.07 mm/year for liners sterilized with gamma irradiation in air and 0.09 ± 0.04 mm/year for liners sterilized with gamma-irradiation with barrier packaging without oxygen. THAs with increased volumetric wear tended to demonstrate larger osteolytic lesions (r = 0.40) and there tended to be less osteolysis among the liners sterilized with gamma-irradiation with barrier packaging without oxygen. However, there was no difference in survivorship among the sterilization groups and there has been no cup or stem loosening associated with osteolysis.
Durable biologic fixation through 10-year followup can be achieved by solely relying on an initial press-fit. Noncrosslinking gas plasma for terminal sterilization of the polyethylene liners was associated with greater head penetration rate than gamma irradiation.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Barrack RL, Butler RA. Avoidance and management of neurovascular injuries in total hip arthroplasty. Instr Course Lect. 2003;52:267–274.
- Chen CJ, Xenos JS, McAuley JP, Young A, Engh CA Sr. Second-generation porous-coated cementless total hip arthroplasties have high survival. Clin Orthop Relat Res. 2006;451:121–127. CrossRef
- Claus AM, Hopper RH Jr, Engh CA. Fractures of the greater trochanter induced by osteolysis with the anatomic medullary locking prosthesis. J Arthroplasty. 2002;17:706–712. CrossRef
- Claus AM, Sychterz CJ, Hopper RH Jr, Engh CA. Pattern of osteolysis around two different cementless metal-backed cups: retrospective, radiographic analysis at minimum 10-year follow-up. J Arthroplasty. 2001;16(8 Suppl 1):177–182. CrossRef
- Costa L, Bracco P, Brach del Prever EM, Kurtz SM, Gallinaro P. Oxidation and oxidation potential in contemporary packaging for polyethylene total joint replacement components. J Biomed Mater Res B Appl Biomater. 2006;78:20–26.
- DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.
- Digas G, Thanner J, Nivbrant B, Röhrl S, Ström H, Kärrholm J. Increase in early polyethylene wear after sterilization with ethylene oxide: radiostereometric analyses of 201 total hips. Acta Orthop Scand. 2003;74:531–541. CrossRef
- Egawa H, Ho H, Hopper RH Jr, Engh CA Jr, Engh CA. Computed tomography assessment of pelvic osteolysis and cup-lesion interface involvement with a press-fit porous-coated acetabular cup. J Arthroplasty. 2009;24:233–239. CrossRef
- Egawa H, Powers CC, Beykirch SE, Hopper RH Jr, Engh CA Jr, Engh CA. Can the volume of pelvic osteolysis be calculated without using computed tomography? Clin Orthop Relat Res. 2009;467:181–187. CrossRef
- Emms NW, Stockley I, Hamer AJ, Wilkinson JM. Long-term outcome of a cementless, hemispherical, press-fit acetabular component: survivorship analysis and dose-response relationship to linear polyethylene wear. J Bone Joint Surg Br. 2010;92:856–861. CrossRef
- Engh CA, Bobyn JD. Principles, techniques, results, and complications with a porous-coated sintered metal system. Instr Course Lect. 1986;35:169–183.
- Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement: the factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987;69:45–55.
- Engh CA, Hopper RH Jr, Engh CA Jr. Long-term porous-coated cup survivorship using spikes, screws, and press-fitting for initial fixation. J Arthroplasty. 2004;19(7 Suppl 2):54–60. CrossRef
- Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-coated femoral components. Clin Orthop Relat Res. 1990;257:107–128.
- Engh CA, O’Connor D, Jasty M, McGovern TF, Bobyn JD, Harris WH. Quantification of implant micromotion, strain shielding, and bone resorption with porous-coated anatomic medullary locking femoral prostheses. Clin Orthop Relat Res. 1992;285:13–29.
- 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. CrossRef
- 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.
- Hamilton WG, Hopper RH Jr, Ginn SD, Hammell NP, Engh CA Jr, Engh CA. The effect of total hip arthroplasty cup design on polyethylene wear rate. J Arthroplasty. 2005;20(7 Suppl 3):63–72. CrossRef
- Hennessy DW, Callaghan JJ, Liu SS. Second-generation extensively porous-coated THA stems at minimum 10-year followup. Clin Orthop Relat Res. 2009;467:2290–2296. CrossRef
- Hopper RH Jr, Engh CA Jr, Fowlkes LB, Engh CA. The pros and cons of polyethylene sterilization with gamma irradiation. Clin Orthop Relat Res. 2004;429:54–62. CrossRef
- Hopper RH Jr, Young AM, Orishimo KF, Engh CA Jr. Effect of terminal sterilization with gas plasma or gamma radiation on wear of polyethylene liners. J Bone Joint Surg Am. 2003;85:464–468.
- 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.
- Ise K, Kawanabe K, Matsusaki T, Shimizu M, Onishi E, Nakamura T. Patient sensitivity to polyethylene particles with cemented total hip arthroplasty. J Arthroplasty. 2007;22:966–973. CrossRef
- Jialiang T, Zhongyou M, Fuxing P, Zongke Z, Bin S, Jing Y. Primary total hip arthroplasty with Duraloc cup in patients younger than 50 years: a 5- to 7-year follow-up study. J Arthroplasty. 2009;24:1184–1187. CrossRef
- Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81. CrossRef
- Kay RM, Dorey FJ, Johnston-Jones K, Cracchiolo A 3rd, Amstutz HC, Finerman GA. Long-term durability of cemented primary total hip arthroplasty. J Arthroplasty. 1995;10(Suppl):S29–S38. CrossRef
- Kitamura N, Leung SB, Engh CA Sr. Characteristics of pelvic osteolysis on computed tomography after total hip arthroplasty. Clin Orthop Relat Res. 2005;441:291–297. CrossRef
- 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.
- Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular migration: an experimental study. J Arthroplasty. 1989;4:245–251. CrossRef
- Mayne IP, Kosashvili Y, White LM, Backstein D. Iliopsoas tendonitis due to the protrusion of an acetabular component fixation screw after total hip arthroplasty. J Arthroplasty. 2010;25:659.e5–8. CrossRef
- McGovern TF, Ammeen DJ, Collier JP, Currier BH, Engh GA. Rapid polyethylene failure of unicondylar tibial components sterilized with gamma irradiation in air and implanted after a long shelf life. J Bone Joint Surg Am. 2002;84:901–906.
- 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.
- Medel FJ, Kurtz SM, Hozack WJ, Parvizi J, Purtill JJ, Sharkey PF, MacDonald D, Kraay MJ, Goldberg V, Rimnac CM. Gamma inert sterilization: a solution to polyethylene oxidation? J Bone Joint Surg Am. 2009;91:839–849. CrossRef
- Muratoglu OK, Merrill EW, Bragdon CR, O’Connor D, Hoeffel D, Burroughs B, Jasty M, Harris WH. Effect of radiation, heat, and aging on in vitro wear resistance of polyethylene. Clin Orthop Relat Res. 2003;417:253–262.
- Puri L, Wixson RL, Stern SH, Kohli J, Hendrix RW, Stulberg SD. Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty. J Bone Joint Surg Am. 2002;84:609–614.
- Roth A, Winzer T, Sander K, Anders JO, Venbrocks RA. Press fit fixation of cementless cups: how much stability do we need indeed? Arch Orthop Trauma Surg. 2006;126:77–81. CrossRef
- Shon WY, Gupta S, Biswal S, Han SH, Hong SJ, Moon JG. Pelvic osteolysis relationship to radiographs and polyethylene wear. J Arthroplasty. 2009;24:743–750. CrossRef
- Stihsen C, Pabinger C, Radl R, Rehak P, Windhager R. Migration of the Duraloc cup after 5 years. Int Orthop. 2008;32:791–794. CrossRef
- Stöckl B, Sandow M, Krismer M, Biedermann R, Wimmer C, Frischhut B. Migration of the Duraloc cup at two years. J Bone Joint Surg Br. 1999;81:51–53. CrossRef
- Sychterz CJ, Claus AM, Engh CA. What we have learned about long-term cementless fixation from autopsy retrievals. Clin Orthop Relat Res. 2002;405:79–91. CrossRef
- Udomkiat P, Dorr LD, Wan Z. Cementless hemispheric porous-coated sockets implanted with press-fit technique without screws: average ten-year follow-up. J Bone Joint Surg Am. 2002;84:1195–1200.
- Wasielewski RC, Crossett LS, Rubash HE. Neural and vascular injury in total hip arthroplasty. Orthop Clin North Am. 1992;23:219–235.
- Zicat B, Engh CA, Gokcen E. Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg Am. 1995;77:432–439.
- The Effect of Poly Sterilization on Wear, Osteolysis and Survivorship of a Press-fit Cup at 10-Year Followup
Clinical Orthopaedics and Related Research®
Volume 470, Issue 2 , pp 462-470
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Anderson Orthopaedic Research Institute, PO Box 7088, Alexandria, VA, 22307, USA
- 2. Inova Center for Joint Replacement at Mount Vernon Hospital, Alexandria, VA, USA