Clinical Orthopaedics and Related Research®

, Volume 468, Issue 12, pp 3228–3233 | Cite as

Highly Crosslinked Polyethylene Reduces Wear in Total Hip Arthroplasty at 5 Years

  • Jonathan Mutimer
  • Peter A. Devane
  • Kathryn Adams
  • J. Geoffrey Horne
Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society



Although hip arthroplasty reliably relieves pain and improves function, problems have arisen with wear and osteolysis. Highly crosslinked polyethylene has been developed to address this problem although at present there is limited clinical evidence it does so longer term.


We compared the in vivo wear of standard versus highly crosslinked polyethylene (HXLP) in primary total hip arthroplasty at a minimum of 5-year followup.


We enrolled 122 patients in a prospective, double-blinded, randomized trial and followed them annually to assess their progress. Annual radiographs were analyzed using previously validated edge detection software to assess for two-dimensional, three-dimensional, and volumetric wear. The mean follow up was 5.5 years (range, 4.1 to 7 years).


The two-dimensional wear measurements for HXLP showed lower wear compared to the conventional group (0.05 mm/year versus 0.26 mm/year, respectively). Three-dimensional and volumetric wear were similarly lower in the HXLP group.


Highly crosslinked polyethylene undergoes substantially less wear than conventional polyethylene at medium term. The effect of hip arthroplasty longevity will need to be assessed with longer-term studies, but this may lead to a decreased need for revision as a result of less wear and osteolysis.

Level of Evidence

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



We thank James Stanley, Department of Public Health, Wellington School of Medicine (Wellington, New Zealand), for his assistance with statistical analysis of the data.


  1. 1.
    Bitsch RG, Loidolt T, Heisel C, Ball S, Schmalzried TP. Reduction of osteolysis with use of Marathon cross-linked polyethylene. A concise follow-up, at a minimum of five years, of a previous report. J Bone Joint Surg Am. 2008;90:1487–1491.CrossRefPubMedGoogle Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    Cooper RA, McAllister CM, Borden LS, Bauer TW. Polyethylene debris-induced osteolysis and loosening in uncemented total hip arthroplasty. A cause of late failure. J Arthroplasty. 1992;7:285–290.CrossRefPubMedGoogle Scholar
  4. 4.
    Currier BH, Currier JH, Mayor MB, Lyford KA, Collier JP, Van Citters DW. Evaluation of oxidation and fatigue damage of retrieved crossfire polyethylene acetabular cups. J Bone Joint Am. 2007;89:2023–2029.CrossRefGoogle Scholar
  5. 5.
    Cushnaghan J, Coggon D, Reading I, Croft P, Byng P, Cox K, Dieppe P, Cooper C. Long-term outcome following total hip arthroplasty: a controlled longitudinal study. Arthritis Rheum. 2007;57:1375–1380.CrossRefPubMedGoogle Scholar
  6. 6.
    D’Antonio JA, Manley MT, Capello WN, Bierbaum BE, Ramakrishnan R, Naughton M, Sutton K. Five-year experience with Crossfire highly cross-linked polyethylene. Clin Orthop Relat Res. 2005;441:143–150.CrossRefPubMedGoogle Scholar
  7. 7.
    Devane PA, Bourne RB, Rorabeck CH, MacDonald S, Robinson EJ. Measurement of polyethylene wear in metal-backed acetabular cups. II. Clinical application. Clin Orthop Relat Res. 1995;319:317–326.PubMedGoogle Scholar
  8. 8.
    Devane PA, Horne JG. Assessment of polyethylene wear in total hip replacement. Clin Orthop Relat Res. 1999;369:59–72.CrossRefPubMedGoogle Scholar
  9. 9.
    Digas G, Kärrholm 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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    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(Suppl 2):17–25.PubMedGoogle Scholar
  12. 12.
    Glyn-Jones S, McLardy-Smith P, Gill HS, Murray DW. The creep and wear of highly cross-linked polyethylene: a three-year randomised, controlled trial using radiostereometric analysis. J Bone Joint Surg Br. 2008;90:556–561.CrossRefPubMedGoogle Scholar
  13. 13.
    Glyn-Jones S, Pandit H, Kwon YM, Doll H, Gill HS, Murray DW. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br. 2009;91:1566–1574.CrossRefPubMedGoogle Scholar
  14. 14.
    Ha YC, Kim SY, Kim HJ, Yoo JJ, Koo KH. Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. Clin Orthop Relat Res. 2007;458:106–110.PubMedGoogle Scholar
  15. 15.
    Heisel C, Silva M, Schmalzried TP. Bearing surface options for total hip replacement in young patients. Instr Course Lect. 2004;53:49–65.PubMedGoogle Scholar
  16. 16.
    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.PubMedGoogle Scholar
  17. 17.
    Kavanagh BF, Dewitz, MA, Ilstrup, DM, Stauffer, RN, Coventry MB. Charnley total hip arthroplasty with cement. Fifteen-year results. J Bone and Joint Surg Am. 1989;71:1496–1503.Google Scholar
  18. 18.
    Ladon D, Doherty A, Newson R, Turner J, Bhamra M, Case CP. Changes in metal levels and chromosome aberrations in the peripheral blood of patients after metal-on-metal hip arthroplasty. J Arthroplasty. 2004;19(8 Suppl 3):78–83.Google Scholar
  19. 19.
    Leung SB, Egawa H, Stepniewski A, Beykirch S, Engh CA Jr, Engh CA Sr. Incidence and volume of pelvic osteolysis at early follow-up with highly cross-linked and noncross-linked polyethylene. J Arthroplasty. 2007;22(Suppl 2):134–139.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    Manning DW, Chiang PP, Martell JM, Galante JO, Harris WH. In vivo comparative wear study of traditional and highly cross-linked polyethylene in total hip arthroplasty. J Arthroplasty. 2005;20:880–886.CrossRefPubMedGoogle Scholar
  23. 23.
    McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB, Chess DG, Charron KD. Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. 2009;91:773–782.CrossRefPubMedGoogle Scholar
  24. 24.
    McKellop H, Shen FW, DiMaio W, Lancaster JG. Wear of gamma-crosslinked polyethylene acetabular cups against roughened femoral balls. Clin Orthop Relat Res. 1999;369:73–82.CrossRefPubMedGoogle Scholar
  25. 25.
    Oparaugo PC, Clarke IC, Malchau H, Herberts P. Correlation of wear debris-induced osteolysis and revision with volumetric wear-rates of polyethylene: a survey of 8 reports in the literature. Acta Orthop Scand. 2001;72:22–28.CrossRefPubMedGoogle Scholar
  26. 26.
    Orishimo KF, Claus AM, Sychterz CJ, Engh CA. Relationship between polyethylene wear and osteolysis in hips with a second-generation porous-coated cementless cup after seven years of follow-up. J Bone Joint Surg Am. 2003;85:1095–1099.PubMedGoogle Scholar
  27. 27.
    Rissanen P, Aro S, Slätis P, Sintonen H, Paavolainen P. Health and quality of life before and after hip or knee arthroplasty. J Arthroplasty. 1995;10:169–175.CrossRefPubMedGoogle Scholar
  28. 28.
    Ritter MA, Albohm MJ, Keating EM, Faris PM, Meding JB. Comparative outcomes of total joint arthroplasty. J Arthroplasty. 1995;10:737–741.CrossRefPubMedGoogle Scholar
  29. 29.
    Santavirta S, Böhler M, Harris WH, Konttinen YT, Lappalainen R, Muratoglu O, Rieker C, Salzer M. Alternative materials to improve total hip replacement tribology. Acta Orthop Scand. 2003;74:380–388.CrossRefPubMedGoogle Scholar
  30. 30.
    Schmalzried TP, Jasty M, Harris WH. Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am. 1992;74;849–863.PubMedGoogle Scholar
  31. 31.
    Sochart DH. Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty. Clin Orthop Relat Res. 1999;363:135–150.CrossRefPubMedGoogle Scholar
  32. 32.
    Triclot P, Grosjean G, El Masri F, Courpied JP, Hamadouche M. A comparison of the penetration rate of two polyethylene acetabular liners of different levels of cross-linking. A prospective randomised trial. J Bone Joint Surg Br. 2007;89:1439–1445.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Jonathan Mutimer
    • 1
    • 2
  • Peter A. Devane
    • 2
  • Kathryn Adams
    • 2
  • J. Geoffrey Horne
    • 2
  1. 1.Cheltenham General HospitalCheltenhamEngland, UK
  2. 2.Division of Orthopedic Surgery, Department of SurgeryWellington School of MedicineWellingtonNew Zealand

Personalised recommendations