Cross-linked polyethylene (PE) for total hip arthroplasty still lacks long-term clinical evidence about its sustained performance in wear reduction and its effect on reducing osteolysis, while concerns persist about oxidation and the higher osteolytic potential of the wear debris.
This 13 years follow-up of a randomized controlled trial (n48 patients) compares the first generation of a moderately cross-linked and annealed PE (Stryker Duration) to conventional, now “historic” PE by measuring wear as linear head penetration (Roman V 1.70) and counting osteolytic cysts on digital radiographs.
Wear rates were significantly (p = 0.005) lower for Duration (0.063 ± 0.027 mm/year) than conventional PE (0.122 ± 0.065 mm/year). This reduction (−48%) compared well to the original simulator prediction (−45%) and even increased with time (−30% at 5 years, −38% at 8 years, −42% at 10 years). Acetabular cysts were less frequent in the Duration (4/13 = 31%) than in conventional group (13/18 = 72%, p = 0.023).
No evidence of oxidative degradation or elevated osteolytic potential of the wear debris was found but reduced wear and less osteolysis at long follow-up.
Wear Rate Wear Particle Small Punch Test Linear Wear Rate Wear Reduction
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.
Highly cross-linked polyethylene
Randomized controlled trial
Ultra-high molecular weight polyethylene
This is a preview of subscription content, log in to check access
Barrack RL, Folgueras A, Munn B, Tvetden D, Sharkey P (1997) Pelvic lysis and polyethylene wear at 5–8 years in an uncemented total hip. Clin Orthop Relat Res 335:211–217PubMedGoogle Scholar
Charnley J, Halley DK (1975) Rate of wear in total hip replacement. Clin Orthop 112:170PubMedGoogle Scholar
DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32PubMedGoogle Scholar
Dowd JE, Sychterz CJ, Young AM, Engh CA (2000) Characterization of long-term femoral-head-penetration rates. Association with and prediction of osteolysis. J Bone Joint Surg Am 82-A(8):1102–1107PubMedGoogle Scholar
Endo M, Tipper JL, Barton DC, Stone MH, Ingham E, Fisher J (2002) Comparison of wear, wear debris and functional biological activity of moderately crosslinked and non-crosslinked polyethylene in hip prostheses. Proc Inst Mech Eng 216 H:111–122. doi:10.1243/0954411021536333Google Scholar
Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191. doi:10.3758/BF03193146PubMedCrossRefGoogle Scholar
Furmanski J, Kraay MJ, Rimnac CM (2011) Crack initiation in retrieved cross-linked highly cross-linked ultrahigh-molecular-weight polyethylene acetabular liners: an investigation of 9 cases. J Arthroplasty 26(5):796–801. doi:10.1016/j.arth.2010.07.016PubMedCrossRefGoogle Scholar
Geerdink CH, Grimm B, Ramakrishnan R, Rondhuis J, Verburg AJ, Tonino AJ (2006) Crosslinked polyethylene compared to conventional polyethylene in total hip replacement: pre-clinical evaluation, in-vitro testing and prospective clinical follow-up study. Acta Orthop 77(5):719–725. doi:10.1080/17453670610012890PubMedCrossRefGoogle Scholar
Geerdink CH, Grimm B, Vencken W, Heyligers IC, Tonino AJ (2008) The determination of linear and angular penetration of the femoral head into the acetabular component as an assessment of wear in total hip replacement: a comparison of four computer-assisted methods. J Bone Joint Surg Br 90(7):839–846. doi:10.1302/0301-620X.90B7.20305PubMedCrossRefGoogle Scholar
Hernigou P, Zilber S, Filippini P, Poignard A (2009) Ceramic-ceramic bearing decreases osteolysis: a 20-year study versus ceramic-polyethylene on the contralateral hip. Clin Orthop Relat Res 467(9):2274–2280. doi:10.1007/s11999-009-0773-2PubMedCrossRefGoogle Scholar
Kurtz SM (2009) UHMWPE biomaterials handbook – ultra-high molecular weight polyethylene in total joint replacement and medical devices, 2nd edn. Elsevier, San DiegoGoogle Scholar
Livermore J, Ilstrup D, Morrey B (1990) Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am 72(4):518–528PubMedGoogle Scholar
Lundberg HJ, Pedersen DR, Baer TE, Muste M, Callaghan JJ, Brown TD (2007) Effects of implant design parameters on fluid convection, potentiating third-body debris ingress into the bearing surface during THA impingement/subluxation. J Biomech 40(8):1676–1685. doi:10.1016/j.jbiomech.2007.01.021PubMedCrossRefGoogle Scholar
Marshall A, Ries MD, Paprosky W (2008) Implant Wear Symposium 2007 Clinical Work Group. How prevalent are implant wear and osteolysis, and how has the scope of osteolysis changed since 2000? J Am Acad Orthop Surg 16(Suppl 1):S1–S6PubMedGoogle Scholar
Thomas GER, Simpson DJ, Mehmood S, Taylor A, McLardy-Smith P, Gill HS, Murray DW, Glyn-Jones S (2011) The seven-year wear of highly cross-linked polyethylene in total hip arthroplasty: a double-blind, randomized controlled trial using radiostereometric analysis. J Bone Joint Surg Am 93(8):716–722. doi:10.2106/JBJS.J.00287PubMedCrossRefGoogle Scholar
ASTM F 2183–02 (2003) Test method for small punch testing of ultra-high molecular weight polyethylene used in surgical implants. Annual book of ASTM standards, vol 13.01. ASTM International, West Conshohocken. doi:10.1520/F2183-02R08