The Survivorship of the Uncemented Iso-Elastic Monoblock Acetabular Component at a Mean of 6-Year Follow-up



Aseptic loosening, caused by wear and osteolysis, is the most frequent reason for hip replacement revision in the UK. To prevent aseptic loosening, an acetabular component with vitamin E added to irradiated highly cross-linked polyethylene (HXLPE) was developed to reduce oxidative degradation.


A prior study of the vitamin E–blended HXLPE acetabular component after 2 years of follow-up reported no adverse reactions or abnormal mechanical behavior. To further examine this hypothesis of reducing wear and osteolysis, we sought to evaluate outcomes after 6-year follow-up.


A cohort of 95 of the 112 initial patients (84.2%) completed the 6 years of follow-up after receiving a vitamin E–blended HXLPE acetabular component. Evaluation was performed in terms of clinical (visual analog scale [VAS] score, VAS score with weight-bearing, VAS score for satisfaction, and Harris Hip Score) and radiological (inclination, polar gap, radiolucencies, migration, and 2-D linear femoral head penetration rate) assessment.


The mean VAS score for patient satisfaction was 8.75 and the mean Harris Hip Score was 91.8. There were two revisions because of deep infections and one because of a peri-prosthetic femoral fracture. Two acetabular components migrated initially; however, delayed acetabular stabilization occurred. Both patients had good clinical scores at 72 months. The mean femoral head penetration rate was 0.036 mm/year.


This prospective cohort study has shown no adverse reactions concerning the vitamin E additive, promising wear rates, no signs of osteolysis, a 100% survival rate for aseptic loosening, and an all-cause survivorship percentage of 97.4% at 6 years of follow-up.

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This study is funded by the Clinical Orthopedic Research Foundation, Diakonessenhuis Zeist.

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Correspondence to T. E. Snijders MD.

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Conflict of Interest

T.E. Snijders, MD, J.J. Halma, MD, J.R.A. Massier, S.M. van Gaalen, MD, PhD, and A. de Gast, MD, PhD, declare that they have no conflict of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

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Informed consent was obtained from all patients for being included in this study.

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Level of Evidence: Level IV, Therapeutic Study

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Snijders, T.E., Halma, J.J., Massier, J.R.A. et al. The Survivorship of the Uncemented Iso-Elastic Monoblock Acetabular Component at a Mean of 6-Year Follow-up. HSS Jrnl 16, 15–22 (2020).

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  • vitamin E
  • polyethylene
  • iso-elastic
  • monoblock cup
  • femoral head penetration
  • total hip arthroplasty