Oxidation Prevention with Vitamin E in a HXLPE Isoelastic Monoblock Pressfit Cup: Preliminary Results

  • Martin Beck
  • Daniel Delfosse
  • Reto Lerf
  • Roland Becker
  • Gary French
  • Lutz Hollmann
  • Karl Knahr
  • Helmy Naeder
  • Eric Meijer
  • Philipp Rehbein
  • Joseph Baines
  • Vincent Steenmeijer
  • Arthur de Gast


The first vitamin-doped HXLPE materials were recently introduced into clinical practice. The protection of HXLPE with vitamin E leads to excellent oxidation resistance. It has a number of important benefits for the material properties, most importantly, the effective prevention of any loss of toughness over the entire life span of the implant. The wear rates of hip simulator testing remain very low even when the implants are subjected to accelerated ageing up to times corresponding to 40 years in vivo.

This paper is the first to report on the clinical performance of vitamin E-blended HXLPE hip implants. From a cohort of 553 cases (528 patients), a 1-year follow-up is available for 164 cases. All patients showed stable implant fixation during the last follow-up performed. There was no sign of early loosening of the cup.


Wear Rate Accelerate Ageing Ceramic Head Excellent Oxidation Resistance Ball Head 
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.


  1. 1.
    Stafford GH, Islam SU, Witt JD (2011) Early to mid-term results of ceramic-on-ceramic total hip replacement: analysis of bearing-surface-related complications. J Bone Joint Surg Br 93(8):1017–1020PubMedCrossRefGoogle Scholar
  2. 2.
    Affatato S, Traina F, Toni A (2011) Microseparation and stripe wear in alumina-on-alumina hip implants. Int J Artif Organs 34(6):506–512PubMedCrossRefGoogle Scholar
  3. 3.
    Stanat SJ, Capozzi JD (2011) Squeaking in third- and fourth-generation ceramic-on-ceramic total hip arthroplasty, meta-analysis and systematic review. J Arthroplasty [Epub ahead of print] doi: 10.1016/j.arth.2011.04.031Google Scholar
  4. 4.
    Aroukatos P, Repanti M, Repantis T et al (2010) Immunologic adverse reaction associated with low-carbide metal-on-metal bearings in total hip arthroplasty. Clin Orthop Relat Res 468(8):2135–2142PubMedCrossRefGoogle Scholar
  5. 5.
    Catelas I, Wimmer MA (2011) New insights into wear and biological effects of metal-on-metal bearings. J Bone Joint Surg Am 93(Suppl 2):76–83PubMedCrossRefGoogle Scholar
  6. 6.
    Langton DJ, Jameson SS, Joyce TJ et al (2010) Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wear. J Bone Joint Surg Br 92(1):38–46PubMedCrossRefGoogle Scholar
  7. 7.
    Langton DJ, Jameson SS, Joyce TJ et al (2011) Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br 93(8):1011–1016PubMedCrossRefGoogle Scholar
  8. 8.
    Dumbleton JH, Manley MT, Edidin AA (2002) A literature review of the association between wear rate and osteolysis in total hip arthroplasty. J Arthroplasty 17(5):649–661PubMedCrossRefGoogle Scholar
  9. 9.
    Kurtz SM, Gawel HA, Patel JD (2011) History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Relat Res 469(8):2262–2277PubMedCrossRefGoogle Scholar
  10. 10.
    Kuzyk PRT, Saccone M, Sprague S et al (2011) Cross-linked versus conventional polyethylene for total hip replacement. J Bone Joint Surg Br 93(5):593–600PubMedCrossRefGoogle Scholar
  11. 11.
    Currier BH, Van Citters DW, Currier JH et al (2010) In vivo oxidation in remelted highly cross-linked retrievals. J Bone Joint Surg Am 92(14):2409–2418PubMedCrossRefGoogle Scholar
  12. 12.
    Lerf R, Zurbrügg D, Delfosse D (2010) Use of vitamin E to protect cross-linked UHMWPE from oxidation. Biomaterials 31(13):3643–3648PubMedCrossRefGoogle Scholar
  13. 13.
    Oral E, Moratoglu OK (2011) Vitamin E diffused, highly crosslinked UHMWPE – a review. Int Orthop 35(2):215–223PubMedCrossRefGoogle Scholar
  14. 14.
    Bracco P, Oral E (2011) Vitamin E-stabilized UHMWPE for total joint implants – a review. Clin Orthop Relat Res 469(8):2286–2293PubMedCrossRefGoogle Scholar
  15. 15.
    Zurbrügg D, Abt NA (2003) Comparison between in vivo aging, shelf and accelerated aging of UHMWPE based on the theory of oxidation kinetics. Poster at 18th European conference on biomaterials, Stuttgart, 1–4 Oct 2003Google Scholar
  16. 16.
    Noordin S, Schmalzried TP, Campbell P et al (1997) Synovial fluid from patients with prosthetic joint arthroplasty: protein concentration and in vivo wear of polyethylene. In: Transactions of the 43rd annual meeting of the Orthopaedic Research Society, San Francisco, 1997, vol 22, p 769Google Scholar
  17. 17.
    Saari H, Santavirta S, Nordstrom D et al (1993) Hyaluronate in total hip replacement. J Rheumatol 20(1):87–90PubMedGoogle Scholar
  18. 18.
    Pakvis D, Biemond L, van Hellemondt G et al (2010) A cementless elastic monoblock socket in young patients: a ten to 18-year clinical and radiological follow-up. Int Orthop 35(10):1445–1451PubMedCrossRefGoogle Scholar
  19. 19.
    Ihle M, Mai S, Pfluger D et al (2008) The results of the titanium-coated RM acetabular component at 20 years: a long-term follow-up of an uncemented primary total hip replacement. J Bone Joint Surg Br 90(10):1284–1290PubMedCrossRefGoogle Scholar
  20. 20.
    Ihle M, Mai S, Siebert WE (2010) Treatment for acetabular dysplasia using the uncemented RM acetabular component – a 20 year follow-up. Hip Int 20(1):94–101PubMedGoogle Scholar

Copyright information

© EFORT 2012

Authors and Affiliations

  • Martin Beck
    • 1
  • Daniel Delfosse
    • 2
  • Reto Lerf
    • 2
  • Roland Becker
    • 3
  • Gary French
    • 4
  • Lutz Hollmann
    • 5
  • Karl Knahr
    • 6
  • Helmy Naeder
    • 7
  • Eric Meijer
    • 8
  • Philipp Rehbein
    • 9
  • Joseph Baines
    • 10
  • Vincent Steenmeijer
    • 11
  • Arthur de Gast
    • 12
  1. 1.Clinic for Orthopaedic SurgeryLuzerner KantonsspitalLucerneSwitzerland
  2. 2.Innovation GroupMathys Ltd BettlachBettlachSwitzerland
  3. 3.Orthopàdic und UnfallchirwgicStädtisches Klinikum Brandenburg GmbHBrandenburgGermany
  4. 4.Orthopaedic DepartmentOrmiston OrthopaedicsManukauNew Zealand
  5. 5.Orthopaedic DepartmentStreekziekenhuis Koningin BeatrixWinterswijkThe Netherlands
  6. 6.Orthopaedic DepartmentOrthopädisches Spital Speising GmbHViennaAustria
  7. 7.Orthopaedic DepartmentBürgerspital SolothurnSolothurnSwitzerland
  8. 8.Orthopaedic DepartmentZiekenhuis AmstellandAmstelveenThe Netherlands
  9. 9.Orthopaedic DepartmentSt. Josefs-HospitalWiesbadenGermany
  10. 10.Orthopaedic DepartmentGolden Jubilee National HospitalClydebankScotland
  11. 11.Orthopaedic DepartmentZiekenhuis BronovoDen HaagThe Netherlands
  12. 12.Orthopaedic DepartmentDiakonessenhuis Utrecht/ZeistUtrechtThe Netherlands

Personalised recommendations