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      Long-term performance of oxidized zirconium on conventional and highly cross-linked polyethylene in total hip arthroplasty


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          Introduction: Polyethylene wear and subsequent osteolysis remain obstacles to the long-term survivorship of total hip arthroplasty (THA). Highly cross-linked polyethylene (XLPE) with radical quenching represents a massive leap forward with dramatically improved wear rates compared to ultra-high molecular weight polyethylene (UHMWPE). In this study we evaluate the wear of UHMWPE and XLPE coupled with oxidized zirconium (OxZr) femoral heads. Methods: A longitudinal, retrospective analysis was performed identifying consecutive patients who received a 28-mm OxZr-on-polyethylene primary THA from 2003 to 2004 by a single, high-volume arthroplasty surgeon. Patients were divided into two groups: those that received (1) UHMWPE liner and (2) a highly XLPE liner. Patients were included if clinical follow-up was complete to 2014 or later. Radiographic analysis was performed by two blinded observers. Measures included cup position, annual linear wear rate, and presence of osteolysis. Pairwise comparisons, correlations, and inter-rater reliability were calculated. Results: Eighty patients were in the UHMWPE group with an average follow-up of 10 ± 1.23 years and 88 patients in the XLPE group with an average of 10 ± 1.03-year follow-up. Average age (68) was similar between groups ( p = 0.288). Observer reliability was excellent for cup abduction (ICC = 0.940), anteversion (ICC = 0.942), and detection of osteolysis (ICC = 0.811). Annual linear wear rates were significantly higher ( p = 1 × 10 −19) with UHMWPE (0.21 ± 0.12 mm/year) compared to XLPE (0.05 ± 0.03 mm/year). Linear wear rate was significantly correlated to decreasing acetabular abduction ( p = 0.035). Osteolysis was noted only in the UHMWPE group, with 17 patients (21.2%) exhibiting acetabular osteolysis and 37 (46.3%) patients exhibiting femoral osteolysis. Conclusions: OxZr coupled with XLPE showed minimal wear and no osteolysis at 10-year follow up. The yearly linear penetration rate is similar to that seen in other studies of XLPE THA. A careful longitudinal follow-up will be required to determine if advanced bearings such as OxZr or ceramic can show improved performance in the second decade of implantation.

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          Radiological Demarcation of Cemented Sockets in Total Hip Replacement

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            Total hip arthroplasties: what are the reasons for revision?

            Primary total hip arthroplasties have reported success rates of greater than 95% in many series with a longer than 10-year follow-up. Revision total hip arthroplasty due to such factors as increased high-activity levels, younger patients undergoing the procedure and increasing life expectancy has become more prevalent. An understanding of the mechanisms and timing of total hip arthroplasty failure can direct efforts aimed at reducing revision rates. This study was conducted to evaluate the indications for revision hip arthroplasty and relate these to the time after the index primary hip arthroplasty. A review of all revision hip arthroplasties at two centres over a 6-year time period identified 225 patients who underwent 237 revisions. The overall mean time to revision was 83 months (range: 0-360 months). The cause of failure was aseptic loosening in 123 hips (51.9%), instability in 40 hips (16.9%) and infection in 37 hips (5.5%). When stratified into two groups (less than 5 years, more than 5 years after the index primary hip arthroplasty), 118 of 237 (50%) revisions occurred in less than 5 years, with 33% due to instability and 24% resulting from infection. The majority of the causes of failure within 5 years in these early revisions were instability and deep infection. The success of hip arthroplasty is likely to be compromized if technical aspects of the surgery for appropriate component positioning and critical protocols to minimise complications such as infection are not given the proper attention.
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              A literature review of the association between wear rate and osteolysis in total hip arthroplasty.

              The establishment of a polyethylene wear rate threshold for the development of osteolysis at the hip would allow surgeons to identify patients at risk for osteolysis and to implement selective, more frequent follow-up. We reviewed publications that met certain criteria for wear and osteolysis measurement. Based on this review, the incidence of osteolysis increases as the rate of wear increases. The literature indicates that osteolysis rarely is observed at a wear rate of <0.1 mm/y. We suggest that a practical wear rate threshold of 0.05 mm/y would eliminate osteolysis. This wear threshold suggests that the new cross-linked polyethylenes would reduce osteolysis, provided that in vivo wear rates mirror those observed in vitro. To facilitate future comparison of published data, we suggest that longitudinal wear studies adopt consistent edge detection-based wear measurement techniques and uniform osteolytic lesion classification and measurement schema. Copyright 2002, Elsevier Science (USA). All rights reserved.

                Author and article information

                Role: Guest Editors
                SICOT J
                SICOT J
                EDP Sciences
                07 May 2020
                : 6
                : ( publisher-idID: sicotj/2020/01 )
                : 10
                [1 ] Hospital for Special Surgery 535 E 70th St. New York 10021 NY USA
                [2 ] Fondren Orthopedic Group 7401 Main St. Houston 77030 TX USA
                Author notes
                [* ]Corresponding author: carlia@ 123456hss.edu
                sicotj200034 10.1051/sicotj/2020010
                © The Authors, published by EDP Sciences, 2020

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 08 April 2020
                : 16 April 2020
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 46, Pages: 6
                Special Issue: “HIP and KNEE Replacement”
                Original Article

                oxidized zirconium,highly cross-linked polyethylene,total hip arthroplasty,long-term outcomes,osteolysis


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