Clinical Orthopaedics and Related Research®

, Volume 471, Issue 2, pp 393–402 | Cite as

The 2012 John Charnley Award: Clinical Multicenter Studies of the Wear Performance of Highly Crosslinked Remelted Polyethylene in THA

  • Charles R. Bragdon
  • Michael Doerner
  • John Martell
  • Bryan Jarrett
  • Henrik Palm
  • Multicenter Study Group
  • Henrik Malchau
Symposium: Papers Presented at the Annual Meetings of The Hip Society



Highly crosslinked polyethylene (HXLPE) in THA was developed to reduce particle-induced periprosthetic osteolysis. A series of clinical studies were initiated to determine the clinical efficacy as judged by patient-reported scores, radiographic osteolysis, and wear analysis of one form of HXLPE.


The purposes of this series of studies were to (1) determine the wear rates of one form of HXLPE; (2) report long-term (7–10 years) patient-reported outcome measures; (3) assess the effect of femoral head size on wear; and (4) determine the incidence of periprosthetic osteolysis.


A single-center and two multicenter studies were conducted on 768 primary patients (head size 26–36 mm) undergoing THA at eight medical centers. Patient-reported outcome scores, radiographic grading for osteolysis, and radiographic wear evaluation were performed.


Serial plain radiographs showed no periprosthetic osteolysis in the three studies. The average femoral head penetration rates did not correlate with time in vivo for patients with standard femoral head sizes. Although there was an indication of higher wear in patients with 36-mm diameter femoral heads, it was below the threshold for producing osteolysis.


The introduction of this HXLPE substantially improved the prognosis of patients after THA up to 13 years as judged by clinical scores, incidence of osteolysis, and polyethylene wear measurements.

Level of Evidence

Level III, therapeutic study. See the Guideline for Authors for a complete description of levels of evidence.


Femoral Head Wear Rate Head Size Volumetric Wear Periprosthetic Osteolysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Christopher Barr for his assistance in data analysis and data presentation assistance.


  1. 1.
    Ayers DC, Hays PL, Drew JM, Eskander MS, Osuch D, Bragdon CR. Two-year radiostereometric analysis evaluation of femoral head penetration in a challenging population of young total hip arthroplasty patients. J Arthroplasty. 2009;24(Suppl):9–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Baker DA, Hastings RS, Pruitt L. Study of fatigue resistance of chemical and radiation crosslinked medical grade ultrahigh molecular weight polyethylene. J Biomed Mater Res. 1999;46:573–581.PubMedCrossRefGoogle Scholar
  3. 3.
    Bragdon C, Jasty M, Muratoglu O, O’Connor D, Harris W. Third-body wear of highly cross-linked polyethylene in a hip simulator. J Arthroplasty. 2003;18:553–561.PubMedCrossRefGoogle Scholar
  4. 4.
    Bragdon CR, Barrett S, Martell JM, Greene ME, Malchau H, Harris WH. Steady state penetration rates of electron beam-irradiated, highly cross-linked polyethylene at an average 45-month follow-up. J Arthroplasty. 2006;21:935–943.PubMedCrossRefGoogle Scholar
  5. 5.
    Bragdon CR, Greene ME, Freiberg AA, Harris WH, Malchau H. Radiostereometric analysis comparison of wear of highly cross-linked polyethylene against 36- vs 28-mm femoral heads. J Arthroplasty. 2007;22(Suppl 2):125–129.PubMedCrossRefGoogle Scholar
  6. 6.
    Bragdon CR, Jasty M, Muratoglu OK, Harris WH. Third-body wear testing of a highly cross-linked acetabular liner: the effect of large femoral head size. J Arthroplasty. 2005;20:379–385.PubMedCrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    Bragdon CR, Martell JM, Greene ME, Estok DM 2nd, Thanner J, Karrholm J, Harris WH, Malchau H. Comparison of femoral head penetration using RSA and the Martell method. Clin Orthop Relat Res. 2006;448:52–57.PubMedCrossRefGoogle Scholar
  9. 9.
    Brinker MR, Lund PJ, Cox DD, Barrack RL. Demographic biases found in scoring instruments of total hip arthroplasty. J Arthroplasty. 1996;11:820–830.PubMedCrossRefGoogle Scholar
  10. 10.
    Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH. Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes. J Arthroplasty. 2005;20:11–19.PubMedCrossRefGoogle Scholar
  11. 11.
    Burroughs BR, Rubash HE, Harris WH. Femoral head sizes larger than 32 mm against highly cross-linked polyethylene. Clin Orthop Relat Res. 2002;405:150–157.PubMedCrossRefGoogle Scholar
  12. 12.
    Campbell P, Ebramzadeh E, Nelson S, Takamura K, De Smet K, Amstutz HC. Histological features of pseudotumor-like tissues from metal-on-metal hips. Clin Orthop Relat Res. 2010;468:2321–2327.PubMedCrossRefGoogle Scholar
  13. 13.
    Chandler D, Glousman R, Hull D, McGuire P, Kim I, Clarke I, Sarmiento A. Prosthetic hip range of motion and impingement. The effects of head and neck geometry. Clin Orthop Relat Res. 1982;166:284–291.PubMedGoogle Scholar
  14. 14.
    Charnley J. Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res. 1970;72:7–21.PubMedGoogle Scholar
  15. 15.
    Charnley J, Halley DK. Rate of wear in total hip replacement. Clin Orthop Relat Res. 1975;112:170–179.PubMedCrossRefGoogle Scholar
  16. 16.
    Charnley J, Kamangar A, Longfield MD. The optimum size of prosthetic heads in relation to the wear of plastic sockets in total replacement of the hip. Med Biol Eng. 1969;7:31–39.PubMedCrossRefGoogle Scholar
  17. 17.
    Dawson J, Fitzpatrick R, Frost S, Gundle R, McLardy-Smith P, Murray D. Evidence for the validity of a patient-based instrument for assessment of outcome after revision hip replacement. J Bone Joint Surg Br. 2001;83:1125–1129.PubMedCrossRefGoogle Scholar
  18. 18.
    Digas G, Karrholm J, Thanner J, Herberts P. 5-year experience of highly cross-linked polyethylene in cemented and uncemented sockets: two randomized studies using radiostereometric analysis. Acta Orthop. 2007;78:746–754.PubMedCrossRefGoogle Scholar
  19. 19.
    Digas G, Karrholm J, Thanner J, Malchau H, Herberts P. Highly cross-linked polyethylene in cemented THA: randomized study of 61 hips. Clin Orthop Relat Res. 2003;417:126–138.PubMedGoogle Scholar
  20. 20.
    Digas G, Karrholm 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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    Endo M, Tipper JL, Barton DC, Stone MH, Ingham E, Fisher J. Comparison of wear, wear debris and functional biological activity of moderately crosslinked and non-crosslinked polyethylenes in hip prostheses. Proc Inst Mech Eng H. 2002;216:111–122.PubMedCrossRefGoogle Scholar
  23. 23.
    Geller JA, Malchau H, Bragdon C, Greene M, Harris WH, Freiberg AA. Large diameter femoral heads on highly cross-linked polyethylene: minimum 3-year results. Clin Orthop Relat Res. 2006;447:53–59.PubMedCrossRefGoogle Scholar
  24. 24.
    Green TR, Fisher J, Matthews JB, Stone MH, Ingham E. Effect of size and dose on bone resorption activity of macrophages by in vitro clinically relevant ultra high molecular weight polyethylene particles. J Biomed Mater Res. 2000;53:490–497.PubMedCrossRefGoogle Scholar
  25. 25.
    Harris W. The problem is osteolysis. Clin Orthop Relat Res. 1995;311:46–53.PubMedGoogle Scholar
  26. 26.
    Harris WH. 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. J Bone Joint Surg Am. 1969;51:737–755.PubMedGoogle Scholar
  27. 27.
    Jasty M, Bragdon C, Jiranek W, Chandler H, Maloney W, Harris WH. Etiology of osteolysis around porous-coated cementless total hip arthroplasties. Clin Orthop Relat Res. 1994;308:111–126.PubMedGoogle Scholar
  28. 28.
    Jasty M, Harris W. Periprosthetic osteolysis. In: Stauffer RS, Ehrlich MG, Fu FH, Kostuik JP, Manske PR, Sim FH, eds. Advances in Operative Orthopaedics. Vol 1. Boston, MA, USA: Mosby Year Book, Inc; 1993:1–22.Google Scholar
  29. 29.
    Jasty MJ, Floyd WE, Schiller AL, Goldring SR, Harris WH. Localized osteolysis in stable, non-septic total hip replacement. J Bone Joint Surg Am. 1986;68:912–919.PubMedGoogle Scholar
  30. 30.
    Karrholm J, Digas G, Thanner J, Herberts P. Five to 7 years experiences with highly cross-linked PE. SICOT TWC Abstract #19059. Hong Kong; 2008. Available at: Accessed December 19, 2011.
  31. 31.
    Kind PH, Macran S. UK Population Norms for EQ-5D. York, UK: The University of York Centre for Health Economics; 1999.Google Scholar
  32. 32.
    Kurtz SM, Muratoglu OK, Evans M, Edidin AA. Advances in the processing, sterilization, and crosslinking of ultra-high molecular weight polyethylene for total joint arthroplasty. Biomaterials. 1999;20:1659–1688.PubMedCrossRefGoogle Scholar
  33. 33.
    Lachiewicz PF, Heckman DS, Soileau ES, Mangla J, Martell JM. Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years. Clin Orthop Relat Res. 2009;467:3290–3296.PubMedCrossRefGoogle Scholar
  34. 34.
    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.PubMedCrossRefGoogle Scholar
  35. 35.
    Malchau H. Introducing new technology: a stepwise algorithm. Spine. 2000;25:285.PubMedCrossRefGoogle Scholar
  36. 36.
    Malchau H, Bragdon CR, Muratoglu OK. The stepwise introduction of innovation into orthopedic surgery: the next level of dilemmas. J Arthroplasty. 2011;26:825–831.PubMedCrossRefGoogle Scholar
  37. 37.
    Mall NA, Nunley RM, Zhu JJ, Maloney WJ, Barrack RL, Clohisy JC. The incidence of acetabular osteolysis in young patients with conventional versus highly crosslinked polyethylene. Clin Orthop Relat Res. 2011;469:372–381.PubMedCrossRefGoogle Scholar
  38. 38.
    Maloney W, Jasty M, Harris W, Galante J, Callaghan J. Endosteal erosion in association with stable uncemented femoral components. J Bone Joint Surg Am. 1990;72:1025–1034.PubMedGoogle Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar
  40. 40.
    Maloney WJ, Jasty M, Rosenberg A, Harris WH. Bone lysis in well-fixed cemented femoral components. J Bone Joint Surg Br. 1990;72:966–970.PubMedGoogle Scholar
  41. 41.
    Martell JM, Berdia S. Determination of polyethylene wear in total hip replacements with use of digital radiographs. J Bone Joint Surg Am. 1997;79:1635–1641.PubMedGoogle Scholar
  42. 42.
    McKellop H, Shen F-W, Lu B, Campbell P, Salovey R. Effect of sterilization method and other modifications on the wear resistance or acetabular cups made of ultra-high molecular weight polyethylene. J Bone Joint Surg Am. 2000;82:1708–1725.PubMedGoogle Scholar
  43. 43.
    Muratoglu OK, Bragdon CR, O’Connor D, Perinchief RS, Estok DM 2nd, Jasty M, Harris WH. Larger diameter femoral heads used in conjunction with a highly cross-linked ultra-high molecular weight polyethylene: a new concept. J Arthroplasty. 2001;16(Suppl 1):24–30.PubMedCrossRefGoogle Scholar
  44. 44.
    Muratoglu OK, Bragdon CR, O’Connor DO, Jasty M, Harris WH. A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties. Recipient of the 1999 HAP Paul Award. J Arthroplasty. 2001;16:149–160.PubMedCrossRefGoogle Scholar
  45. 45.
    Muratoglu OK, Bragdon CR, O’Connor DO, Jasty M, Harris WH, Gul R, McGarry F. Unified wear model for highly crosslinked ultra-high molecular weight polyethylenes (UHMWPE). Biomaterials. 1999;20:1463–1470.PubMedCrossRefGoogle Scholar
  46. 46.
    Naal FD, Impellizzeri FM, Leunig M. Which is the best activity rating scale for patients undergoing total joint arthroplasty? Clin Orthop Relat Res. 2009;467:958–965.PubMedCrossRefGoogle Scholar
  47. 47.
    Rohrl S, Nivbrant B, Mingguo L, Hewitt B. In vivo wear and migration of highly cross-linked polyethylene cups a radiostereometry analysis study. J Arthroplasty. 2005;20:409–413.PubMedCrossRefGoogle Scholar
  48. 48.
    Shahrdar C. Pseudotumor in large-diameter metal-on-metal total hip articulation. J Arthroplasty. 2011;26:665.e21–23.Google Scholar
  49. 49.
    Stanat SJ, Capozzi JD. Squeaking in third- and fourth-generation ceramic-on-ceramic total hip arthroplasty meta-analysis and systematic review. J Arthroplasty. 2012;27:445–453.PubMedCrossRefGoogle Scholar
  50. 50.
    Walter WL, O’Toole GC, Walter WK, Ellis A, Zicat BA. Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplasty. 2007;22:496–503.PubMedCrossRefGoogle Scholar
  51. 51.
    Weinstein JN, Lurie JD, Tosteson TD, Skinner JS, Hanscom B, Tosteson AN, Herkowitz H, Fischgrund J, Cammisa FP, Albert T, Deyo RA. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006;296:2451–2459.PubMedCrossRefGoogle Scholar
  52. 52.
    Willert HG, Bertram H, Buchhorn GH. Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles. Clin Orthop Relat Res. 1990;258:95–107.PubMedGoogle Scholar
  53. 53.
    Wirth MA, Agrawal CM, Mabrey JD, Dean DD, Blanchard CR, Miller MA, Rockwood CA Jr. Isolation and characterization of polyethylene wear debris associated with osteolysis following total shoulder arthroplasty. J Bone Joint Surg Am. 1999;81:29–37.PubMedGoogle Scholar
  54. 54.
    Wroblewski BM. Charnley low-frictional torque arthroplasty of the hip. In: Faux JC, ed. After Charnley. Preston, UK: The John Charnley Trust; 2002:29–35.Google Scholar
  55. 55.
    Zicat B, Engh C, Gokcen E. Patterns of osteolysis around total hip components inserted with and without cement. J Bone Joint Surg Am. 1995;77:432–439.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Charles R. Bragdon
    • 1
  • Michael Doerner
    • 1
  • John Martell
    • 2
  • Bryan Jarrett
    • 1
  • Henrik Palm
    • 3
  • Multicenter Study Group
  • Henrik Malchau
    • 1
  1. 1.The Harris Orthopaedic LaboratoryMassachusetts General HospitalBostonUSA
  2. 2.University of Chicago Medical CenterChicagoUSA
  3. 3.Hvidovre University HospitalCopenhagenDenmark

Personalised recommendations