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Highly Crosslinked Polyethylene Improves Wear But Not Surface Damage in Retrieved Acetabular Liners

  • Symposium: 2014 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Highly crosslinked polyethylene (XLPE) is believed to demonstrate better wear resistance than conventional polyethylene (CPE) in total hip arthroplasty.

Questions/purposes

The purpose of this study was to compare visual damage scores and micro-CT measurements of penetration, a surrogate for wear, between matched retrieved XLPE and CPE acetabular liners.

Methods

Thirteen XLPE acetabular liners were matched in terms of implant design (all were of the same design), patient age, sex, liner dimensions, duration of implantation, and reason for revision to a group of CPE liners that were retrieved in the same time period. Penetration resulting from the combination of wear and creep in the two groups of liners was measured with micro-CT. Surface damage was scored by two blinded observers using a surface damage system that considers the seven common damage modes: pitting, scratching, burnishing, abrasions, impingement, embedded debris, and delamination, and wear patterns were documented.

Results

There was no difference (p = 0.32) in total damage score between the XLPE group (14 ± 4) and the CPE group (15 ± 5). However, there was three times greater penetration (odds ratio, 3.1; confidence interval, 2.3–5.1; p < 0.001) in the CPE group (0.18 ± 0.09 mm/year) than in the XLPE group (0.05 ± 0.07 mm/year). There was less volumetric loss in XLPE (82 ± SD 134 mm3) versus the CPE group (350 ± SD 342 mm3; p = 0.017).

Conclusions

XLPE liners undergo less penetration as a result of creep and wear than CPE liners based on quantitative measurements provided by micro-CT, which was not apparent using damage scoring alone. This demonstrates the use of three-dimensional imaging techniques such as micro-CT for quantifying wear in retrieval studies.

Clinical Relevance

In this study, XLPE had less wear but similar damage scores than CPE, allaying concerns that the beneficial wear properties of XLPE might come with a tradeoff arising from the increased brittleness of that material.

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Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, 339 Windemere Road, London, ON, N6A 5A5, Canada

    Hee-Nee Pang MD, Douglas D. R. Naudie MD, Richard W. McCalden MD, Steven J. MacDonald MD & Matthew G. Teeter PhD

Authors
  1. Hee-Nee Pang MD
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  2. Douglas D. R. Naudie MD
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  3. Richard W. McCalden MD
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  4. Steven J. MacDonald MD
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  5. Matthew G. Teeter PhD
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Corresponding author

Correspondence to Richard W. McCalden MD.

Additional information

One or more of the authors or the department with which they are affiliated have received institutional and/or research support from DePuy Orthopaedics (Warsaw, IN, USA; SJM); Smith & Nephew (Memphis, TN, USA; DDRN, RWM, MGT); and Stryker Orthopaedics (Mahwah, NJ, USA; DDRN).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Pang, HN., Naudie, D.D.R., McCalden, R.W. et al. Highly Crosslinked Polyethylene Improves Wear But Not Surface Damage in Retrieved Acetabular Liners. Clin Orthop Relat Res 473, 463–468 (2015). https://doi.org/10.1007/s11999-014-3858-5

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  • DOI: https://doi.org/10.1007/s11999-014-3858-5

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