Skip to main content
SpringerLink
Log in

Highly Cross-Linked Polyethylene in Cementless Total Hip Arthroplasty in Patients with Previous Acetabular Fractures: A Minimum 5-Year Follow-Up Study

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Outcomes of THA after acetabular fracture are generally less favorable than those of the nontraumatic arthritis due to a higher rate of cup loosening and osteolysis. We, therefore, investigated whether highly cross-linked polyethylene liners positively impact outcomes of THA in patients with posttraumatic osteoarthritis after acetabular fracture.

Methods

We retrospectively evaluated 39 patients with previous acetabular fracture who underwent THA using highly cross-linked polyethylene liner after a mean 8.5 year follow-up. All procedures were performed at a single institution by a single surgeon using the same type of THA implants. Wear measurements were performed using a computer-assisted PolyWare software. Osteolysis was evaluated with use of radiography and computed tomography.

Results

The mean preoperative Harris hip score was 44.4 points, which improved to 93.1 points at final follow-up. Neither femoral nor acetabular components displayed mechanical loosening and no components had been revised. Radiographs and CT scans did not demonstrate osteolysis. The mean linear wear was 0.043 mm/y (range 0–0.098 mm/y). With the data available, univariate regression analysis suggests that age, gender, weight, initial fracture type, the duration of follow-up, activity level, liner thickness, acetabular cup inclination, and the necessity of bone graft had no influence on liner penetration.

Conclusion

While the long-term effects of the polyethylene particles from highly cross-linked polyethylene remain unknown, implant survivorship and wear data in this study are promising for this high-risk population. Our encouraging results support the continued use of this type of polyethylene in patients after acetabular fractures.

Level of Evidence

Level IV Therapeutic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

THA:

Total hip arthroplasty

HXLPE:

Highly cross-linked polyethylene

ORIF:

Open reduction and internal fixation

UHMWPE:

Ultra-high-molecular-weight polyethylene

MRSA:

Methicillin-resistant Staphylococcus aureus

CT:

Computed tomography

TIFF:

Tagged image file format

References

  1. Romness, D. W., & Lewallen, D. G. (1990). Total hip arthroplasty after fracture of the acetabulum. Long-term results. Journal of Bone Joint Surgery British, 72(5), 761–764.

    Article  CAS  Google Scholar 

  2. Min, B. W., Lee, K. J., Song, K. S., Bae, K. C., & Cho, C. H. (2013). Highly cross-linked polyethylene in total hip arthroplasty for osteonecrosis of the femoral head: a minimum 5-year follow-up study. Journal of Arthropedic, 28(3), 526–530. https://doi.org/10.1016/j.arth.2012.07.010.

    Article  Google Scholar 

  3. Dowd, J. E., Sychterz, C. J., Young, A. M., & Engh, C. A. (2000). Characterization of long-term femoral head penetration rates. Association with and prediction of osteolysis. Journal of Bone Joint Surgery American, 82(8), 1102–1107.

    Article  CAS  Google Scholar 

  4. Kim, Y. H., Choi, Y., & Kim, J. S. (2010). Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis. International Orthopedic, 34(8), 1123–1127. https://doi.org/10.1007/s00264-009-0878-y.

    Article  Google Scholar 

  5. Yoo, J. J., Kim, Y. M., Yoon, K. S., Koo, K. H., Kim, J. W., Nam, K. W., et al. (2006). Contemporary alumina-on-alumina total hip arthroplasty performed in patients younger than forty years: a 5-year minimum follow-up study. Journal of Biomedical Materials Research, 78(1), 70–75. https://doi.org/10.1002/jbm.b.30457.

    Article  CAS  Google Scholar 

  6. Baek, S. H., & Kim, S. Y. (2008). Cementless total hip arthroplasty with alumina bearings in patients younger than fifty with femoral head osteonecrosis. Journal of Bone Joint Surgery American, 90(6), 1314–1320. https://doi.org/10.2106/jbjs.g.00755.

    Article  Google Scholar 

  7. Dastane, M. R., Long, W. T., Wan, Z., Chao, L., & Dorr, L. D. (2008). Metal-on-metal hip arthroplasty does equally well in osteonecrosis and osteoarthritis. Clinical Orthopedic Relation Respective, 466(5), 1148–1153. https://doi.org/10.1007/s11999-008-0180-0.

    Article  Google Scholar 

  8. Judet, R., Judet, J., & Letournel, E. (1964). Fractures of the acetabulum:classification and surgical approaches for open reduction preliminary report. Journal of Bone Joint Surgery American, 46, 1615–1646.

    Article  CAS  Google Scholar 

  9. Dorr, L. D., Absatz, M., Gruen, T. A., Saberi, M. T., & Doerzbacher, J. F. (1990). Anatomic porous replacement hip arthroplasty: first 100 consecutive cases. Semin Arthroplasty, 1(1), 77–86.

    CAS  Google Scholar 

  10. Feldman, D. S., Lonner, J. H., Desai, P., & Zuckerman, J. D. (1995). The role of intraoperative frozen sections in revision total joint arthroplasty. Journal of Bone Joint Surgery, 77(12), 1807–1813.

    Article  CAS  Google Scholar 

  11. Paprosky, W. G., Perona, P. G., & Lawrence, J. M. (1994). Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. Journal of Arthroplasty, 9(1), 33–44.

    Article  CAS  Google Scholar 

  12. Harris, W. H. (1969). 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. Journal of Bone Joint Surgery American, 51(4), 737–755.

    Article  CAS  Google Scholar 

  13. Johnston, R. C., Fitzgerald, R. H., Jr., Harris, W. H., Poss, R., Muller, M. E., & Sledge, C. B. (1990). Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. Journal Bone Joint Surgery American, 72(2), 161–168.

    Article  CAS  Google Scholar 

  14. Massin, P., Schmidt, L., & Engh, C. A. (1989). Evaluation of cementless acetabular component migration. Journal of Arthroplasty, 4(3), 245–251.

    Article  CAS  Google Scholar 

  15. Zicat, B., Engh, C. A., & Gokcen, E. (1995). Patterns of osteolysis around total hip components inserted with and without cement. Journal of Bone Joint Surgery American, 77(3), 432–439.

    Article  CAS  Google Scholar 

  16. DeLee, J. G., & Charnley, J. (1976). Radiological demarcation of cemented sockets in total hip replacement. Clinical Orthopedic Relation Respective, 121, 20–32.

    Google Scholar 

  17. Gruen, T. A., McNeice, G. M., & Amstutz, H. C. (1979). “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clinical Orthopedic Relation Respective, 141, 17–27.

    Google Scholar 

  18. Devane, P. A., & Horne, J. G. (1999). Assessment of polyethylene wear in total hip replacement. Clinical Orthopedic Relation Respective, 369, 59–72.

    Article  Google Scholar 

  19. Glyn-Jones, S., McLardy-Smith, P., Gill, H. S., & Murray, D. W. (2008). The creep and wear of highly cross-linked polyethylene: a three-year randomised, controlled trial using radiostereometric analysis. Journal of Bone Joint Surgery, 90(5), 556–561. https://doi.org/10.1302/0301-620x.90b5.20545.

    Article  CAS  Google Scholar 

  20. Brooker, A. F., Bowerman, J. W., Robinson, R. A., & Riley, L. H., Jr. (1973). Ectopic ossification following total hip replacement. Incidence and a method of classification. Journal of Bone Joint Surgery American, 55(8), 1629–1632.

    Article  CAS  Google Scholar 

  21. Wan, Z., & Dorr, L. D. (1996). Natural history of femoral focal osteolysis with proximal ingrowth smooth stem implant. Journal of Arthroplasty, 11(6), 718–725.

    Article  CAS  Google Scholar 

  22. Shon, W. Y., Gupta, S., Biswal, S., Han, S. H., Hong, S. J., & Moon, J. G. (2009). Pelvic osteolysis relationship to radiographs and polyethylene wear. Journal of Arthroplasty, 24(5), 743–750. https://doi.org/10.1016/j.arth.2008.02.012.

    Article  Google Scholar 

  23. Nebergall, A. K., Greene, M. E., Rubash, H., Malchau, H., Troelsen, A., & Rolfson, O. (2016). Thirteen-year evaluation of highly cross-linked polyethylene articulating with either 28-mm or 36-mm femoral heads using radiostereometric analysis and computerized tomography. Journal of Arthroplasty, 31(9), 269–276. https://doi.org/10.1016/j.arth.2016.02.076.

    Article  Google Scholar 

  24. Aldinger PR, Jung AW, Pritsch M, Breusch S, Thomsen M, Ewerbeck V, Parsch D (2009) Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age Fifteen to twenty-year results. Journal of Bone Joint Surgery American 91(6):1432-1439. 10.2106/jbjs.h.00297

  25. Ranawat, A., Zelken, J., Helfet, D., & Buly, R. (2009). Total hip arthroplasty for posttraumatic arthritis after acetabular fracture. Journal of Arthroplasty, 24(5), 759–767. https://doi.org/10.1016/j.arth.2008.04.004.

    Article  Google Scholar 

  26. Zhang, L., Zhou, Y., Li, Y., Xu, H., Guo, X., & Zhou, Y. (2011). Total hip arthroplasty for failed treatment of acetabular fractures: a 5-year follow-up study. Journal of Arthroplasty, 26(8), 1189–1193. https://doi.org/10.1016/j.arth.2011.02.024.

    Article  Google Scholar 

  27. Gavaskar, A. S., Gopalan, H., Karthik, B., Srinivasan, P., & Tummala, N. C. (2017). Delayed total hip arthroplasty for failed acetabular fractures: the influence of initial fracture management on outcome after arthroplasty. Journal of Arthroplasty, 32(3), 872–876. https://doi.org/10.1016/j.arth.2016.09.007.

    Article  Google Scholar 

  28. Weber, M., Berry, D. J., & Harmsen, W. S. (1998). Total hip arthroplasty after operative treatment of an acetabular fracture. Journal Bone Joint Surgery American, 80(9), 1295–1305.

    Article  CAS  Google Scholar 

  29. Bellabarba, C., Berger, R. A., Bentley, C. D., Quigley, L. R., Jacobs, J. J., Rosenberg, A. G., et al. (2001). Cementless acetabular reconstruction after acetabular fracture. Journal Bone Joint Surgery American, 83(6), 868–876.

    Article  CAS  Google Scholar 

  30. Babovic, N., & Trousdale, R. T. (2013). Total hip arthroplasty using highly cross-linked polyethylene in patients younger than 50 years with minimum 10-year follow-up. Journal of Arthroplasty, 28(5), 815–817. https://doi.org/10.1016/j.arth.2012.12.005.

    Article  Google Scholar 

  31. Kim, Y. H., Park, J. W., Patel, C., & Kim, D. Y. (2013). Polyethylene wear and osteolysis after cementless total hip arthroplasty with alumina-on-highly cross-linked polyethylene bearings in patients younger than thirty years of age. Journel Bone Joint Surgery American, 95(12), 1088–1093. https://doi.org/10.2106/jbjs.l.01211.

    Article  Google Scholar 

  32. Kim, Y. H., Choi, Y., & Kim, J. S. (2011). Cementless total hip arthroplasty with alumina-on-highly cross-linked polyethylene bearing in young patients with femoral head osteonecrosis. Journal of Arthroplasty, 26(2), 218–223. https://doi.org/10.1016/j.arth.2010.03.010.

    Article  CAS  Google Scholar 

  33. Garvin, K. L., Hartman, C. W., Mangla, J., Murdoch, N., & Martell, J. M. (2009). Wear analysis in THA utilizing oxidized zirconium and crosslinked polyethylene. Clinical Orthopedic Relation Respective, 467(1), 141–145. https://doi.org/10.1007/s11999-008-0544-5.

    Article  Google Scholar 

  34. Kim, S. Y., Kyung, H. S., Ihn, J. C., Cho, M. R., Koo, K. H., & Kim, C. Y. (2004). Cementless metasul metal-on-metal total hip arthroplasty in patients less than fifty years old. Journel Bone Joint Surgery American, 86(11), 2475–2481.

    Article  Google Scholar 

  35. Willert, H. G., Buchhorn, G. H., Fayyazi, A., Flury, R., Windler, M., Koster, G., et al. (2005). Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. Journel Bone Joint Surgery American, 87(1), 28–36. https://doi.org/10.2106/JBJS.A.02039.

    Article  Google Scholar 

  36. Park, Y. S., Moon, Y. W., Lim, S. J., Yang, J. M., Ahn, G., & Choi, Y. L. (2005). Early osteolysis following second-generation metal-on-metal hip replacement. Journel Bone Joint Surgery American, 87(7), 1515–1521. https://doi.org/10.2106/jbjs.d.02641.

    Article  Google Scholar 

  37. Capello, W. N., D'Antonio, J. A., Manley, M. T., & Feinberg, J. R. (2005). Arc-deposited hydroxyapatite-coated cups: results at 4–7 years. Clinical Orthopedic Relation Respective, 441, 305–312.

    Article  Google Scholar 

  38. Hannouche, D., Nich, C., Bizot, P., Meunier, A., Nizard, R., & Sedel, L. (2003). Fractures of ceramic bearings: history and present status. Clinical Orthopedic Relation Respective, 417, 19–26. https://doi.org/10.1097/01.blo.0000096806.78689.50.

    Article  Google Scholar 

  39. Walter, W. L., O'Toole, G. C., Walter, W. K., Ellis, A., & Zicat, B. A. (2007). Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. Journal of Arthroplasty, 22(4), 496–503. https://doi.org/10.1016/j.arth.2006.06.018.

    Article  Google Scholar 

Download references

Funding

No external funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Keimyung University, Daegu, Korea

    Byung-Woo Min, Ki-Cheor Bae, Chul-Hyun Cho, Eun-Suck Son, Kyung-Jae Lee & Si-Wook Lee

  2. Department of Orthopaedic Surgery, Dongsan Hospital, Keimyung University, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Korea

    Byung-Woo Min, Ki-Cheor Bae, Chul-Hyun Cho, Eun-Suck Son, Kyung-Jae Lee & Si-Wook Lee

Authors
  1. Byung-Woo Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ki-Cheor Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chul-Hyun Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eun-Suck Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyung-Jae Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Si-Wook Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BWM and KJL conceived the study, and participated in its design and coordination. BWM and KJL performed the operation. KCB and CHC collected and analyzed the data. ESS, KJL, and SWL contributed to methodology, supervision, validation, and writing of the original draft. All authors interpreted the data and participated in drafting the text and tables. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kyung-Jae Lee.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Ethics Approval

This study was approved by institutional review board of Keimyung University Dongsan Hospital (approval number 2018-02-014).

Informed Consent

Not applicable.

Availability of Data and Material

All the data generated and/or analyzed during the current study are available from the corresponding author by reasonable request.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Min, BW., Bae, KC., Cho, CH. et al. Highly Cross-Linked Polyethylene in Cementless Total Hip Arthroplasty in Patients with Previous Acetabular Fractures: A Minimum 5-Year Follow-Up Study. JOIO 54 (Suppl 2), 239–245 (2020). https://doi.org/10.1007/s43465-020-00137-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-020-00137-z

Keywords

Search

Navigation