Highly Crosslinked Polyethylene Reduces Wear in Total Hip Arthroplasty at 5 Years
- 324 Downloads
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.
- 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
- 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
- 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.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