TITLE

The Seven-Year Wear of Highly Cross-Linked Polyethylene in Total Hip Arthroplasty

AUTHOR(S)
Thomas, Geraint E.R.; Simpson, David J.; Mehmood, Shahid; Taylor, Adrian; McLardy-Smith, Peter; Gill, Harinderjit Singh; Murray, David W.; Glyn-Jones, Siôn
PUB. DATE
April 2011
SOURCE
Journal of Bone & Joint Surgery, American Volume;4/20/2011, Vol. 93-A Issue 8, p716
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The use of highly cross-linked polyethylene is now commonplace in total hip arthroplasty. Hip simulator studies and short-term in vivo measurements have suggested that the wear rate of highly cross-linked polyethylene is significantly less than that of conventional ultra-high molecular weight polyethylene. However, long-term data to support its use are limited. The aim of this study was to compare the intermediate-term steady-state wear of highly cross-linked polyethylene compared with that of conventional ultra-high molecular weight polyethylene acetabular liners in a pro- spective, double-blind, randomized controlled trial with use of radiostereometric analysis. Methods: Fifty-four patients were randomized to receive hip replacements with either conventional ultra-high molecular weight polyethylene acetabular liners (Zimmer) or highly cross-linked polyethylene liners (Longevity; Zimmer). All patients received a cemented, collarless, polished, tapered femoral component (CPT; Zimmer) and an uncemented acetabular component (Trilogy; Zimmer). Clinical outcomes were assessed and the three-dimensional penetration of the head into the socket was determined for a minimum of seven years. Linear regression was used to calculate the steady-state wear rate following the creep-dominated penetration seen during the first year. Results: At a minimum of seven years postoperatively, the mean total femoral head penetration was significantly lower in the highly cross-linked polyethylene group (0.33 mm; 95% confidence interval [Cl], ±0.10 mm) than it was in the ultra- high molecular weight polyethylene group (0.55 mm; 95% Cl, ±0.10 mm)(p = 0.005). The mean steady-state wear rate of highly cross-linked polyethylene was 0.005 mm/yr (95% CI, ±0.015 mm/yr), compared with 0.037 mm/yr (95% Cl, ±0.019 mm/yr) for conventional ultra-high molecular weight polyethylene (p = 0.007). No patient in the highly cross-linked polyethylene group had a wear rate above the osteolysis threshold of 0.1 mm/yr, compared with 9% of patients in the ultra-high molecular weight polyethylene group. Conclusions: This study demonstrates that highly cross-linked polyethylene has a significantly lower steady-state wear rate compared with that of conventional ultra-high molecular weight polyethylene. Longer-term follow-up is required to determine if this will translate into improved clinical performance and longevity of these implants.
ACCESSION #
60439341

 

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