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The 2012 John Charnley Award: Clinical Multicenter Studies of the Wear Performance of Highly Crosslinked Remelted Polyethylene in THA

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Highly crosslinked polyethylene (HXLPE) in THA was developed to reduce particle-induced periprosthetic osteolysis. A series of clinical studies were initiated to determine the clinical efficacy as judged by patient-reported scores, radiographic osteolysis, and wear analysis of one form of HXLPE.

Questions/purposes

The purposes of this series of studies were to (1) determine the wear rates of one form of HXLPE; (2) report long-term (7–10 years) patient-reported outcome measures; (3) assess the effect of femoral head size on wear; and (4) determine the incidence of periprosthetic osteolysis.

Methods

A single-center and two multicenter studies were conducted on 768 primary patients (head size 26–36 mm) undergoing THA at eight medical centers. Patient-reported outcome scores, radiographic grading for osteolysis, and radiographic wear evaluation were performed.

Results

Serial plain radiographs showed no periprosthetic osteolysis in the three studies. The average femoral head penetration rates did not correlate with time in vivo for patients with standard femoral head sizes. Although there was an indication of higher wear in patients with 36-mm diameter femoral heads, it was below the threshold for producing osteolysis.

Conclusions

The introduction of this HXLPE substantially improved the prognosis of patients after THA up to 13 years as judged by clinical scores, incidence of osteolysis, and polyethylene wear measurements.

Level of Evidence

Level III, therapeutic study. See the Guideline for Authors for a complete description of levels of evidence.

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References

  1. Ayers DC, Hays PL, Drew JM, Eskander MS, Osuch D, Bragdon CR. Two-year radiostereometric analysis evaluation of femoral head penetration in a challenging population of young total hip arthroplasty patients. J Arthroplasty. 2009;24(Suppl):9–14.

    Article  PubMed  Google Scholar 

  2. Baker DA, Hastings RS, Pruitt L. Study of fatigue resistance of chemical and radiation crosslinked medical grade ultrahigh molecular weight polyethylene. J Biomed Mater Res. 1999;46:573–581.

    Article  PubMed  CAS  Google Scholar 

  3. Bragdon C, Jasty M, Muratoglu O, O’Connor D, Harris W. Third-body wear of highly cross-linked polyethylene in a hip simulator. J Arthroplasty. 2003;18:553–561.

    Article  PubMed  Google Scholar 

  4. Bragdon CR, Barrett S, Martell JM, Greene ME, Malchau H, Harris WH. Steady state penetration rates of electron beam-irradiated, highly cross-linked polyethylene at an average 45-month follow-up. J Arthroplasty. 2006;21:935–943.

    Article  PubMed  Google Scholar 

  5. Bragdon CR, Greene ME, Freiberg AA, Harris WH, Malchau H. Radiostereometric analysis comparison of wear of highly cross-linked polyethylene against 36- vs 28-mm femoral heads. J Arthroplasty. 2007;22(Suppl 2):125–129.

    Article  PubMed  Google Scholar 

  6. Bragdon CR, Jasty M, Muratoglu OK, Harris WH. Third-body wear testing of a highly cross-linked acetabular liner: the effect of large femoral head size. J Arthroplasty. 2005;20:379–385.

    Article  PubMed  Google Scholar 

  7. 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.

    PubMed  Google Scholar 

  8. Bragdon CR, Martell JM, Greene ME, Estok DM 2nd, Thanner J, Karrholm J, Harris WH, Malchau H. Comparison of femoral head penetration using RSA and the Martell method. Clin Orthop Relat Res. 2006;448:52–57.

    Article  PubMed  Google Scholar 

  9. Brinker MR, Lund PJ, Cox DD, Barrack RL. Demographic biases found in scoring instruments of total hip arthroplasty. J Arthroplasty. 1996;11:820–830.

    Article  PubMed  CAS  Google Scholar 

  10. Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH. Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes. J Arthroplasty. 2005;20:11–19.

    Article  PubMed  Google Scholar 

  11. Burroughs BR, Rubash HE, Harris WH. Femoral head sizes larger than 32 mm against highly cross-linked polyethylene. Clin Orthop Relat Res. 2002;405:150–157.

    Article  PubMed  Google Scholar 

  12. Campbell P, Ebramzadeh E, Nelson S, Takamura K, De Smet K, Amstutz HC. Histological features of pseudotumor-like tissues from metal-on-metal hips. Clin Orthop Relat Res. 2010;468:2321–2327.

    Article  PubMed  Google Scholar 

  13. Chandler D, Glousman R, Hull D, McGuire P, Kim I, Clarke I, Sarmiento A. Prosthetic hip range of motion and impingement. The effects of head and neck geometry. Clin Orthop Relat Res. 1982;166:284–291.

    PubMed  Google Scholar 

  14. Charnley J. Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res. 1970;72:7–21.

    PubMed  CAS  Google Scholar 

  15. Charnley J, Halley DK. Rate of wear in total hip replacement. Clin Orthop Relat Res. 1975;112:170–179.

    Article  PubMed  Google Scholar 

  16. Charnley J, Kamangar A, Longfield MD. The optimum size of prosthetic heads in relation to the wear of plastic sockets in total replacement of the hip. Med Biol Eng. 1969;7:31–39.

    Article  PubMed  CAS  Google Scholar 

  17. Dawson J, Fitzpatrick R, Frost S, Gundle R, McLardy-Smith P, Murray D. Evidence for the validity of a patient-based instrument for assessment of outcome after revision hip replacement. J Bone Joint Surg Br. 2001;83:1125–1129.

    Article  PubMed  CAS  Google Scholar 

  18. Digas G, Karrholm J, Thanner J, Herberts P. 5-year experience of highly cross-linked polyethylene in cemented and uncemented sockets: two randomized studies using radiostereometric analysis. Acta Orthop. 2007;78:746–754.

    Article  PubMed  Google Scholar 

  19. 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.

    PubMed  Google Scholar 

  20. Digas G, Karrholm J, Thanner J, Malchau H, Herberts P. The Otto Aufranc Award. Highly cross-linked polyethylene in total hip arthroplasty: randomized evaluation of penetration rate in cemented and uncemented sockets using radiostereometric analysis. Clin Orthop Relat Res. 2004;429:6–16.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  CAS  Google Scholar 

  23. Geller JA, Malchau H, Bragdon C, Greene M, Harris WH, Freiberg AA. Large diameter femoral heads on highly cross-linked polyethylene: minimum 3-year results. Clin Orthop Relat Res. 2006;447:53–59.

    Article  PubMed  Google Scholar 

  24. Green TR, Fisher J, Matthews JB, Stone MH, Ingham E. Effect of size and dose on bone resorption activity of macrophages by in vitro clinically relevant ultra high molecular weight polyethylene particles. J Biomed Mater Res. 2000;53:490–497.

    Article  PubMed  CAS  Google Scholar 

  25. Harris W. The problem is osteolysis. Clin Orthop Relat Res. 1995;311:46–53.

    PubMed  Google Scholar 

  26. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.

    PubMed  CAS  Google Scholar 

  27. Jasty M, Bragdon C, Jiranek W, Chandler H, Maloney W, Harris WH. Etiology of osteolysis around porous-coated cementless total hip arthroplasties. Clin Orthop Relat Res. 1994;308:111–126.

    PubMed  Google Scholar 

  28. Jasty M, Harris W. Periprosthetic osteolysis. In: Stauffer RS, Ehrlich MG, Fu FH, Kostuik JP, Manske PR, Sim FH, eds. Advances in Operative Orthopaedics. Vol 1. Boston, MA, USA: Mosby Year Book, Inc; 1993:1–22.

    Google Scholar 

  29. Jasty MJ, Floyd WE, Schiller AL, Goldring SR, Harris WH. Localized osteolysis in stable, non-septic total hip replacement. J Bone Joint Surg Am. 1986;68:912–919.

    PubMed  CAS  Google Scholar 

  30. Karrholm J, Digas G, Thanner J, Herberts P. Five to 7 years experiences with highly cross-linked PE. SICOT TWC Abstract #19059. Hong Kong; 2008. Available at: http://www.sicot.org/. Accessed December 19, 2011.

  31. Kind PH, Macran S. UK Population Norms for EQ-5D. York, UK: The University of York Centre for Health Economics; 1999.

    Google Scholar 

  32. Kurtz SM, Muratoglu OK, Evans M, Edidin AA. Advances in the processing, sterilization, and crosslinking of ultra-high molecular weight polyethylene for total joint arthroplasty. Biomaterials. 1999;20:1659–1688.

    Article  PubMed  CAS  Google Scholar 

  33. Lachiewicz PF, Heckman DS, Soileau ES, Mangla J, Martell JM. Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years. Clin Orthop Relat Res. 2009;467:3290–3296.

    Article  PubMed  Google Scholar 

  34. Mai K, Verioti C, Ezzet KA, Copp SN, Walker RH, Colwell CW Jr. Incidence of ‘squeaking’ after ceramic-on-ceramic total hip arthroplasty. Clin Orthop Relat Res. 2010;468:413–417.

    Article  PubMed  Google Scholar 

  35. Malchau H. Introducing new technology: a stepwise algorithm. Spine. 2000;25:285.

    Article  PubMed  CAS  Google Scholar 

  36. Malchau H, Bragdon CR, Muratoglu OK. The stepwise introduction of innovation into orthopedic surgery: the next level of dilemmas. J Arthroplasty. 2011;26:825–831.

    Article  PubMed  Google Scholar 

  37. Mall NA, Nunley RM, Zhu JJ, Maloney WJ, Barrack RL, Clohisy JC. The incidence of acetabular osteolysis in young patients with conventional versus highly crosslinked polyethylene. Clin Orthop Relat Res. 2011;469:372–381.

    Article  PubMed  Google Scholar 

  38. Maloney W, Jasty M, Harris W, Galante J, Callaghan J. Endosteal erosion in association with stable uncemented femoral components. J Bone Joint Surg Am. 1990;72:1025–1034.

    PubMed  CAS  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. Maloney WJ, Jasty M, Rosenberg A, Harris WH. Bone lysis in well-fixed cemented femoral components. J Bone Joint Surg Br. 1990;72:966–970.

    PubMed  CAS  Google Scholar 

  41. 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  CAS  Google Scholar 

  42. McKellop H, Shen F-W, Lu B, Campbell P, Salovey R. Effect of sterilization method and other modifications on the wear resistance or acetabular cups made of ultra-high molecular weight polyethylene. J Bone Joint Surg Am. 2000;82:1708–1725.

    PubMed  Google Scholar 

  43. Muratoglu OK, Bragdon CR, O’Connor D, Perinchief RS, Estok DM 2nd, Jasty M, Harris WH. Larger diameter femoral heads used in conjunction with a highly cross-linked ultra-high molecular weight polyethylene: a new concept. J Arthroplasty. 2001;16(Suppl 1):24–30.

    Article  PubMed  CAS  Google Scholar 

  44. Muratoglu OK, Bragdon CR, O’Connor DO, Jasty M, Harris WH. A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties. Recipient of the 1999 HAP Paul Award. J Arthroplasty. 2001;16:149–160.

    Article  PubMed  CAS  Google Scholar 

  45. Muratoglu OK, Bragdon CR, O’Connor DO, Jasty M, Harris WH, Gul R, McGarry F. Unified wear model for highly crosslinked ultra-high molecular weight polyethylenes (UHMWPE). Biomaterials. 1999;20:1463–1470.

    Article  PubMed  CAS  Google Scholar 

  46. Naal FD, Impellizzeri FM, Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res. 2009;467:958–965.

    Article  PubMed  Google Scholar 

  47. Rohrl S, Nivbrant B, Mingguo L, Hewitt B. In vivo wear and migration of highly cross-linked polyethylene cups a radiostereometry analysis study. J Arthroplasty. 2005;20:409–413.

    Article  PubMed  Google Scholar 

  48. Shahrdar C. Pseudotumor in large-diameter metal-on-metal total hip articulation. J Arthroplasty. 2011;26:665.e21–23.

    Google Scholar 

  49. Stanat SJ, Capozzi JD. Squeaking in third- and fourth-generation ceramic-on-ceramic total hip arthroplasty meta-analysis and systematic review. J Arthroplasty. 2012;27:445–453.

    Article  PubMed  Google Scholar 

  50. Walter WL, O’Toole GC, Walter WK, Ellis A, Zicat BA. Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplasty. 2007;22:496–503.

    Article  PubMed  Google Scholar 

  51. Weinstein JN, Lurie JD, Tosteson TD, Skinner JS, Hanscom B, Tosteson AN, Herkowitz H, Fischgrund J, Cammisa FP, Albert T, Deyo RA. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006;296:2451–2459.

    Article  PubMed  CAS  Google Scholar 

  52. 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.

    PubMed  Google Scholar 

  53. Wirth MA, Agrawal CM, Mabrey JD, Dean DD, Blanchard CR, Miller MA, Rockwood CA Jr. Isolation and characterization of polyethylene wear debris associated with osteolysis following total shoulder arthroplasty. J Bone Joint Surg Am. 1999;81:29–37.

    PubMed  CAS  Google Scholar 

  54. Wroblewski BM. Charnley low-frictional torque arthroplasty of the hip. In: Faux JC, ed. After Charnley. Preston, UK: The John Charnley Trust; 2002:29–35.

    Google Scholar 

  55. Zicat B, Engh C, Gokcen E. Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg Am. 1995;77:432–439.

    PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Christopher Barr for his assistance in data analysis and data presentation assistance.

Author information

Authors and Affiliations

  1. The Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA, 02114, USA

    Charles R. Bragdon PhD, Michael Doerner BS, Bryan Jarrett BS & Henrik Malchau MD, PhD

  2. University of Chicago Medical Center, Chicago, IL, USA

    John Martell MD

  3. Hvidovre University Hospital, Copenhagen, Denmark

    Henrik Palm MD

Authors
  1. Charles R. Bragdon PhD
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  2. Michael Doerner BS
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  4. Bryan Jarrett BS
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  5. Henrik Palm MD
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  6. Henrik Malchau MD, PhD
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Consortia

Multicenter Study Group

Corresponding author

Correspondence to Charles R. Bragdon PhD.

Additional information

Multicenter Study Group: Harry E. Rubash MD, Young-Min Kwon MD, PhD, John Clohisy MD, Richard White MD, Craig Della Valle MD, Daniel Berry MD, Paul F. Lachiewicz MD, Kim Bertin MD, Per-Erik Johanson MD, William H. Harris MD

H. E. Rubash, Y.-M. Kim, W. H. Harris

Massachusetts General Hospital, Boston, MA, USA

J. Clohisy

Washington University in St Louis, St Louis, MO, USA

R. White

Presbyterian Hospital, Albuquerque, NM, USA

C. Della Valle

Rush University Medical Center, Chicago, IL, USA

D. Berry

Mayo Medical School, Rochester, MN, USA

P. F. Lachiewicz

Chapel Hill Orthopedic Surgery and Sports Medicine, Chapel Hill, NC, USA

K. Bertin

Utah Bone & Joint Center, Salt Lake City, UT, USA

P.-E. Johanson

Sahlgrenska University Hospital, Gothenburg, Sweden

One of the authors (CDV) certifies he has or may receive payments or benefits, in any one year, an amount in excess of $10,000 from a commercial entity (Biomet, Warsaw, IN, USA, and Smith & Nephew, Memphis TN, USA). One of the authors (KB) certifies that he has or may receive payments or benefits, during the study period, an amount of more than $1,000,001 from Zimmer Inc (Warsaw, IN, USA) and DePuy Ortho Inc (Warsaw, IN, USA). One of the authors (DB) certifies that he has or may receive payments or benefits, during the study period, an amount of more than $1,000,001 from DePuy Ortho Inc. The institution of two contributors (PL, DB) receives research funds From (DePuy Ortho Inc or Zimmer Inc). The institution of one or more of the authors (CRB, MD, BJ, YMK, HM, PEJ, DB, JC) received funding from Zimmer Inc, Curing Hip Disease Fund, DePuy, and/or the William H. Harris Foundation. Seven contributors (JC, MD, YMK, BJ, PEJ, HP, HM) certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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 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 was obtained if needed.

This work was performed at The Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA USA.

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Bragdon, C.R., Doerner, M., Martell, J. et al. The 2012 John Charnley Award: Clinical Multicenter Studies of the Wear Performance of Highly Crosslinked Remelted Polyethylene in THA. Clin Orthop Relat Res 471, 393–402 (2013). https://doi.org/10.1007/s11999-012-2604-0

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