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Metal-on-crosslinked polyethylene in total hip arthroplasty – an excellent combination at fifteen to twenty years of follow-up

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Abstract

Purpose

Cross-linked polyethylene (PE) has been used with great clinical success in total hip arthroplasty (THA) since its debut in the late 1990’s. However, reports regarding this bearing couple near the end of its second decade of service are still scant. The aim of this study was to first determine the long term clinical and radiological results and second Investigate what factors affect wear rates using a metal-on-crosslinked PE bearing articulation.

Methods

55 THAs using a single brand of cross-linked liner, cementless cup and 28 mm hip ball were performed in 44 patients. Age, sex, Charlson Comorbidity Index (CCI) and need for revision surgery were recorded. Linear and volumetric wear was determined using the Martell method.

Results

Mean age at operation was 51.2 (29–73 ± 12.1) years. Mean duration of follow-up was 16.9 years (range 15.0–20.1 ± 1.1 years). Osteolysis was not present in the latest follow-up radiographs.

Median linear and volumetric wear rate was 0.038 mm/year (95% CI 0.032–0.047) and 7.115mm3/year (95% CI 6.92–17.25) respectively. Acetabular component position was not found to be related to both linear and volumetric wear. No significant difference was found in the linear and volumetric wear rates of thinner and thicker liners (8 mm or below and > 8 mm) (p = 0.849 and p = 0.64 respectively).

Conclusion

Metal-on-crosslinked PE is associated with low linear and volumetric wear rates which has virtually obviated osteolysis and has translated to excellent survivorship even at long term follow up. In-vivo oxidation does not appear to be of clinical concern at this point.

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Data availability

Research data is not available publicly to protect patient privacy.

Code availability

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Acknowledgements

The authors would like to acknowledge the contribution of Dr. Thomas Tang and Mr. Lison Fung for their assistance in data collection.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China

    Amy Cheung, Ping Keung Chan, Henry Fu, Man Hong Cheung, Vincent Wai Kwan Chan, Michelle Hilda Luk & Kwong-Yuen Chiu

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Amy Cheung. The first draft of the manuscript was written by Amy Cheung and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Amy Cheung.

Ethics declarations

Ethics approval

This study has been approved by the Institutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster (UW 21–745).

Consent for publication

Consent for publication from participants was not needed owing to the retrospective nature of this study and this has been approved by the local Institutional Review Board.

Informed consent

Informed consent from participants was not needed owing to the retrospective nature of this study and this has been approved by the local Institutional Review Board.

Conflict of interest

Dr. PK Chan is a paid speaker for Stryker, Depuy Johnson and Johnson, Zimmer Biomet and Smith and Nephew.

Dr. Fu is a paid speaker for Stryker, Depuy Johnson and Johnson, Zimmer Biomet and Smith and Nephew. He also receives research support from Smith and Nephew as a principal investigator.

Dr. MH Cheung is a paid consultant for Zimmer Biomet.

Professor Chiu is a paid consultant for Depuy Johnson and Johnson, Smith and Nephew, Stryker Mako and Zimmer Biomet.

Dr. A Cheung, VWK Chan and MH Luk have no relevant financial or non-financial interests to disclose.

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Cheung, A., Chan, P.K., Fu, H. et al. Metal-on-crosslinked polyethylene in total hip arthroplasty – an excellent combination at fifteen to twenty years of follow-up. International Orthopaedics (SICOT) 47, 2547–2552 (2023). https://doi.org/10.1007/s00264-023-05844-4

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