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The John Charnley Award: Highly Crosslinked Polyethylene in Total Hip Arthroplasty Decreases Long-term Wear: A Double-blind Randomized Trial

  • Symposium: 2014 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 26 August 2014

Abstract

Background

The use of highly crosslinked polyethylene (HXLPE) is now commonplace for total hip arthroplasty. Hip simulator studies and short-term in vivo measurements suggest that the wear rate of some types of HXLPE is significantly less than conventional ultrahigh-molecular-weight polyethylene (UHMWPE). However, there are few long-term data to support its use.

Questions/purposes

The aim of this study was to measure the long-term steady-state wear of HXLPE compared with UHMWPE liners in a prospective, double-blind, randomized controlled trial using radiostereometric analysis.

Methods

Fifty-four patients were randomized to receive hip arthroplasties with either UHMWPE liners or HXLPE liners. Complete followup was available on 39 of these patients (72%). All patients received the same cemented stem and an uncemented acetabular component. Three-dimensional penetration of the head into the socket was determined at 10 years using a radiostereometric analysis system, which has an in vivo accuracy of < 0.1 mm. Oxford Hip Scores were compared between the groups.

Results

At 10 years there was significantly less wear of HXLPE (0.003 mm/year; 95% confidence interval [CI], ± 0.010; SD 0.023; range, −0.057 to 0.074) compared with UHMWPE (0.030 mm/year; 95% CI, ± 0.012; p < 0.001; SD 0.0.27; range, −0.001 to 0.164). The volumetric penetration from 1 to 10 years for the UHMWPE group was 98 mm3 (95% CI, ± 46 mm3; SD 102 mm3; range, −4 to 430 mm3) compared with 14 mm3 (95% CI, ± 40 mm3; SD 91 mm3; range, −189 to 242 mm3) for the HXLPE group (p = 0.01).

Conclusions

This study demonstrates that HXLPE has little detectable steady-state in vivo wear. This may result in fewer reoperations from loosening; however, careful clinical followup into the second decade still needs to be performed.

Level of Evidence

Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

Geraint E. R. Thomas was the presenter and recipient of the John Charnley Award at The Hip Society Open Meeting 2014. We thank Mrs Vicky Flanagan and Mrs Barbara Marks for their assistance during patient recruitment and followup.

Author information

Authors and Affiliations

  1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK

    Siôn Glyn-Jones FRCS, DPhil, Geraint E. R. Thomas MA, MRCS, Patrick Garfjeld-Roberts MA, MRCS, Roger Gundle FRCS, DPhil, Adrian Taylor FRCS, Peter McLardy-Smith FRCS & David W. Murray FRCS, MD

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  1. Siôn Glyn-Jones FRCS, DPhil
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  2. Geraint E. R. Thomas MA, MRCS
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  4. Roger Gundle FRCS, DPhil
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  6. Peter McLardy-Smith FRCS
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  7. David W. Murray FRCS, MD
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Corresponding author

Correspondence to Geraint E. R. Thomas MA, MRCS.

Additional information

One of the authors (GERT) has received funding from Orthopaedic Research UK and the Jean Shanks Foundation. The institution of the authors has received research funding from Zimmer, Inc (Warsaw, IN, USA). Internal funding was received from the Oxford NIHR Biomedical Research Unit in Musculoskeletal Disease. One or more authors (SG-J, AT) certify that he or she or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from a commercial entity (Zimmer, Inc).

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 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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Glyn-Jones, S., Thomas, G.E.R., Garfjeld-Roberts, P. et al. The John Charnley Award: Highly Crosslinked Polyethylene in Total Hip Arthroplasty Decreases Long-term Wear: A Double-blind Randomized Trial. Clin Orthop Relat Res 473, 432–438 (2015). https://doi.org/10.1007/s11999-014-3735-2

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