Date: 19 Jan 2013
Wear of a 5 Megarad Cross-linked Polyethylene Liner: A 6-year RSA Study
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One cross-linked polyethylene (XLPE) liner is manufactured using a lower dose of radiation, 5 Mrad, which may result in less cross-linking. The reported in vivo wear rate of this XLPE liner in patients undergoing THA has varied, and has included some patients in each reported cohort who had greater than 0.1 mm/year of wear, which is an historical threshold for osteolysis. Previous studies have measured wear on plain radiographs, an approach that has limited sensitivity.
We therefore measured the amount and direction of wear at 6 years using Radiostereometric analysis (RSA) in patients who had THAs that included a cross-linked polyethylene liner manufactured using 5 Mrad radiation.
We prospectively reviewed wear in 30 patients who underwent primary THAs with the same design of cross-linked acetabular liner and a 28-mm articulation. Tantalum markers were inserted during surgery and all patients had RSA radiographic examinations at 1 week, 6 months, 1, 2, and 6 years postoperatively.
The mean proximal, two-dimensional (2-D) and three-dimensional (3-D) wear rates calculated between 1 year and 6 years were 0.014, 0.014, and 0.018 mm/per year, respectively. The direction of the head penetration recorded between 1 week and 6 years was in a proximal direction for all patients, proximolateral for 16 of 24 patients, and proximomedial for eight of 24 patients.
The proximal, 2-D and 3-D wear of a XLPE liner produced using 5 Mrad of radiation was low but measurable by RSA after 6 years. No patients had proximal 2-D or 3-D wear rates exceeding 0.1 mm/year. Further followup is needed to evaluate the effect of XLPE wear particles on the development of long-term osteolysis.
The institution of one or more of the authors (GM) has received, during the study period, funding from Depuy (Warsaw, IN, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.
Each author certifies that his 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.
This work was performed at the Repatriation General Hospital, Adelaide, South Australia, Australia.
Campbell D, Mercer G, Nilsson K, Wells V, Field JR, Callary SA. Wear of a highly cross-linked polyethylene liner: a preliminary RSA study. Eur J Orthop Surg Traumatol. 2010;20:23–27.CrossRef
Dunbar MJ, Blackley HR, Bourne RB. Osteolysis of the femur: principles of management. Instr Course Lect. 2001;50:197–209.PubMed
Ebramzadeh E, Sangiorgio SN, Lattuada F, Kang JS, Chiesa R, McKellop HA, Dorr LD. Accuracy of measurement of polyethylene wear with use of radiographs of total hip replacements. J Bone Joint Surg Am. 2003;85:2378–2384.PubMed
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(6 suppl 2):17–25.PubMedCrossRef
Garcia-Cimbrelo E, Munuera L. Early and late loosening of the acetabular cup after low-friction arthroplasty. J Bone Joint Surg Am. 1992;74:1119–1129.PubMed
Harris WH. The problem is osteolysis. Clin Orthop Relat Res. 1995;311:46–53.PubMed
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.PubMed
Jacobs JJ, Campbell PA, T Konttinen Y; Implant Wear Symposium 2007 Biologic Work Group. How has the biologic reaction to wear particles changed with newer bearing surfaces? J Am Acad Orthop Surg. 2008;16(suppl 1):S49–55.PubMed
Karrholm J, Herberts P, Hultmark P, Malchau H, Nivbrant B, Thanner J. Radiostereometry of hip prostheses: review of methodology and clinical results. Clin Orthop Relat Res. 1997;344:94–110.PubMed
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.PubMed
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.PubMed
Thomas GE, Simpson DJ, Mehmood S, Taylor A, McLardy-Smith P, Singh Gill H, Murray DW, Glyn-Jones S. The seven-year wear of highly cross-linked polyethylene in total hip arthroplasty: a double-blind, randomized controlled trial using radiostereometric analysis. J Bone Joint Surg Am. 2011;93:716–722.PubMedCrossRef
- Wear of a 5 Megarad Cross-linked Polyethylene Liner: A 6-year RSA Study
Clinical Orthopaedics and Related Research®
Volume 471, Issue 7 , pp 2238-2244
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- 1. Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, Australia
- 2. Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Level 4, Bice Bldg, North Terrace, Adelaide, SA, 5000, Australia
- 3. Orthopaedic Unit, Repatriation General Hospital, Adelaide, SA, Australia
- 4. Department of Orthopaedics, Umeå University, Umeå, Sweden
- 5. Comparative Orthopaedic Research Surgical Facility, Flinders University, Adelaide, SA, Australia