Clinical Orthopaedics and Related Research®

, Volume 469, Issue 8, pp 2262–2277

History and Systematic Review of Wear and Osteolysis Outcomes for First-generation Highly Crosslinked Polyethylene

  • Steven M. Kurtz
  • Heather A. Gawel
  • Jasmine D. Patel
Symposium: UHMWPE for Arthroplasty: From Powder to Debris

DOI: 10.1007/s11999-011-1872-4

Cite this article as:
Kurtz, S.M., Gawel, H.A. & Patel, J.D. Clin Orthop Relat Res (2011) 469: 2262. doi:10.1007/s11999-011-1872-4



Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and osteolysis in total joint arthroplasty. While many studies report wear and osteolysis associated with HXLPE, analytical techniques, clinical study design and followup, HXLPE formulation and implant design characteristics, and patient populations differ substantially among investigations, complicating a unified perspective.


Literature on first-generation HXLPE was summarized. We systematically reviewed the radiographic wear data and incidence of osteolysis for HXLPE in hip and knee arthroplasty.


PubMed identified 391 studies; 28 met inclusion criteria for a weighted-averages analysis of two-dimensional femoral head penetration rates. To determine the incidence of osteolysis, we estimated a pooled odds ratio using a random-effects model.


Weighted-averages analyses of femoral head penetration rates in HXLPE liners and conventional UHMWPE liners resulted, respectively, in a mean two-dimensional linear penetration rate of 0.042 mm/year based on 28 studies (n = 1503 hips) and 0.137 mm/year based on 18 studies (n = 695 hips). The pooled odds ratio for the risk of osteolysis in HXLPE versus conventional liners was 0.13 (95% confidence interval, 0.06–0.27) among studies with minimum 5-year followup. We identified two clinical studies of HXLPE in TKA, preventing systematic analysis of outcomes.


HXLPE liner studies consistently report lower femoral head penetration and an 87% lower risk of osteolysis. Reduction in femoral head penetration or osteolysis risk is not established for large-diameter (> 32 mm) metallic femoral heads or ceramic femoral heads of any size. Few studies document the clinical performance of HXLPE in knees.

Supplementary material

11999_2011_1872_MOESM1_ESM.xls (82 kb)
Supplementary material 1 (XLS 82 kb)

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Steven M. Kurtz
    • 1
    • 2
  • Heather A. Gawel
    • 2
  • Jasmine D. Patel
    • 1
    • 2
  1. 1.Exponent, IncPhiladelphiaUSA
  2. 2.Drexel UniversityPhiladelphiaUSA

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