Wear Rate of Highly Cross-Linked Polyethylene in Total Hip Arthroplasty: A Randomized Controlled Trial

McCalden, Richard W.; MacDonald, Steven J.; Rorabeck, Cecil H.; Bourne, Robert B.; Chess, David G.; Charron, Kory D.
April 2009
Journal of Bone & Joint Surgery, American Volume;Apr2009, Vol. 91-A Issue 4, p773
Academic Journal
Background: Highly cross-linked polyethylene was introduced for clinical use in total hip arthroplasty with the expectation that it would exhibit less wear when compared with conventional polyethylene. The purpose of this study was to report the clinical and radiographic results, after a minimum of five years of follow-up, of a randomized, blinded, controlled trial comparing a conventional polyethylene with a first-generation highly cross-linked polyethylene. Methods: One hundred patients were enrolled in a prospective, randomized controlled study comparing highly cross- linked and conventional polyethylene acetabular liners in total hip arthroplasty. Fifty patients were in each group. At the time of follow-up, clinical outcomes were assessed and steady-state femoral head penetration rates (after bedding-in) for each patient were calculated with use of a validated radiographic technique. In addition, a statistical comparison of polyethylene wear between groups was performed with use of generalized estimating equations. Results: At a mean of 6.8 years postoperatively, there were no differences between the two polyethylene groups with regard to the Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), or Short Form-12 (SF-12) score. The mean femoral head penetration rate in the first through fifth years was found to be significantly lower in the group treated with the highly cross-linked polyethylene (0.003 mm/yr [95% confidence interval, ±0.027]) than it was in the group treated with conventional polyethylene (0.051 mm/yr [95% confidence interval, ±0.022]) (p = 0.006). Men treated with a conventional polyethylene liner had a significantly higher (p ≤ 0.012) femoral head penetration rate (0.081 mm/yr [95% confidence interval, ±0.065]) than both men and women with a highly cross-linked liner (-0.013 mm/yr [95% confidence interval, ±0.074] and 0.009 mm/yr [95% confidence interval, ±0.028], respectively). The general estimating equations demonstrated that the group with a highly cross-linked polyethylene liner had a significantly lower femoral head penetration rate than the group with a conventional polyethylene liner (p = 0.025), and a significantly higher femoral head penetration rate was demonstrated in men with a conventional polyethylene liner when compared with both men and women with a highly cross-linked liner (p = 0.003). Conclusions: At a minimum of five years postoperatively, the steady-state femoral head penetration rate associated with this first-generation highly cross-linked polyethylene liner was significantly lower than that associated with a conventional polyethylene liner. Long-term follow-up is required to demonstrate the clinical benefit of this new material. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Characterization of the Running-in Period in Total Hip Resurfacing Arthroplasty: An in Vivo and in Vitro Metal Ion Analysis. Heisel, Christian; Streich, Nikolaus; Krachler, Michael; Jakubowitz, Eike; Kretzer, J. Philippe // Journal of Bone & Joint Surgery, American Volume;Aug2008 Supplement 3, Vol. 90-A, p125 

    Background: Metal-on-metal total hip resurfacing arthroplasty is increasingly being performed in young and active patients. Preclinical in vitro testing of implants is usually performed with use of hip simulators, and the serum metal ion concentration is determined for the purpose of monitoring...

  • Tribological Considerations in Primary and Revision Metal-on-Metal Arthroplasty. Lee, Reginald; Essner, Aaron; Wang, Aiguo // Journal of Bone & Joint Surgery, American Volume;Aug2008 Supplement 3, Vol. 90-A, p118 

    Background: Metal-on-metal hip bearings undergo biphasic wear, starting with a short period of high wear (bedding-in) and followed by low steady-state wear. Bedding-in is the process by which the cup wears locally to conform to the geometry of the head. This process reduces the maximum contact...

  • Design Considerations and Life Prediction of Metal-on-Metal Bearings: The Effect of Clearance. Tuke, Michael A.; Scott, Gareth; Roques, Anne; Hu, Xiao Q.; Taylor, Andrew // Journal of Bone & Joint Surgery, American Volume;Aug2008 Supplement 3, Vol. 90-A, p134 

    Background: Clinical observations suggest that metal-on-metal arthroplasties that have been implanted for more than twenty years do fail. It is proposed that there are not two, but three distinct phases of wear life for any metal-on-metal implant system: bedding-in, steady state, and end point....

  • Enhancement of Periprosthetic Bone Quality with Topical Hydroxyapatite-Bisphosphonate Composite. Suratwala, Sanjeev J.; Cho, Samuel K.; van Raalte, Jonathan J.; Sang Hyun Park; Sung Wook Seo; Seong-Sil Chang; Gardner, Thomas R.; Francis Young-In Lee // Journal of Bone & Joint Surgery, American Volume;Oct2008, Vol. 90-A Issue 10, p2189 

    Background: Implant loosening is associated with inflammatory bone loss induced by ultra-high molecular weight polyethylene wear debris. We hypothesized that a hydroxyapatite-bisphosphonate composite improves periprosthetic bone quality and osseous integration of an intramedullary implant even...

  • Retrospective Analysis of Titanium Plate-Retained Prostheses Placed After Total Rhinectomy. Sandner, Annett; Bloching, Marc // International Journal of Oral & Maxillofacial Implants;2009, Vol. 24 Issue 1, p118 

    Purpose: To report the use of a new platelike system (Titanium Epiplating System, Medicon, Tuttlingen, Germany) for rehabilitation of patients after total rhinectomy. Materials and Methods: This retrospective study was conducted on all patients treated between August 2001 and July 2006 with...

  • Rotator Cuff Repair Augmentation in a Canine Model with Use of a Woven Poly-L-Lactide Device. Derwin, Kathleen A.; Codsi, Michael J.; Milks, Ryan A.; Baker, Andrew R.; McCarron, Jesse A.; Iannotti, Joseph P. // Journal of Bone & Joint Surgery, American Volume;May2009, Vol. 91-A Issue 5, p1159 

    Background: Despite advances in surgical treatment options, failure rates of rotator cuff repair have continued to range from 20% to 90%. Hence, there is a need for new repair strategies that provide effective mechanical reinforcement of rotator cuff repair as well as stimulate and enhance the...

  • A Prospective Study of 3 Weeks' Loading of Chemically Modified Titanium Implants in the Maxillary Molar Region: 1-year Results. Roccuzzo, Mario; Wilson, Jr, Thomas G. // International Journal of Oral & Maxillofacial Implants;2009, Vol. 24 Issue 1, p65 

    Purpose: Recent research has demonstrated that modification of implant surface chemistry can influence osseointegration events, leading to increased bone-to-implant contact at earlier times. Clinical studies have been initiated to investigate the potential of modified surfaces to reduce the...

  • Placement of Posterior Maxillary Implants in Partially Edentulous Patients with Severe Bone Deficiency Using CAD/CAM Guidance to Avoid Sinus Grafting: A Clinical Report of Procedure. Fortin, Thomas; Isidori, Michel; Bouchet, Hervé // International Journal of Oral & Maxillofacial Implants;2009, Vol. 24 Issue 1, p96 

    Purpose: To provide a detailed presentation of computer-aided design/computer-assisted manufacture guidance in severely resorbed posterior maxillae to place implants in a very limited amount of bone, thus avoiding sinus grafting. Materials and Methods: Based on computerized tomography (CT) axial...

  • Clinical digest. Trial proves apremilast is effective long-term treatment for psoriasis.  // Nursing Standard;10/10/2012, Vol. 27 Issue 6, p14 

    The article discusses research in the article "Efficacy of Apremilast in the Treatment of Moderate to Severe Psoriasis: A Randomised Controlled Trial" by K. Papp et al. which found that the drug apremilast is effective for the long term treatment of psoriasis.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics