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      Low Wear Rates Seen in THAs With Highly Crosslinked Polyethylene at 9 to 14 Years in Patients Younger Than Age 50 Years

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          Abstract

          <div class="section"> <a class="named-anchor" id="d13716497e124"> <!-- named anchor --> </a> <h5 class="section-title" id="d13716497e125">Background</h5> <p id="d13716497e127">Patients 50 years or younger are at high risk for wear-related complications of their total hip arthroplasty (THA) because of their generally higher levels of activity. Highly crosslinked polyethylene (HXLPE) is believed to be more durable for this population than conventional polyethylene because of its improved wear; however, limited information is available on the wear of HXLPE in this population, particularly the wear of HXLPE when it articulates with alternative bearings like Oxinium (Smith &amp; Nephew, Memphis, TN, USA). </p> </div><div class="section"> <a class="named-anchor" id="d13716497e129"> <!-- named anchor --> </a> <h5 class="section-title" id="d13716497e130">Questions/purposes</h5> <p id="d13716497e132">The purpose of this study was to evaluate two questions relative to this population of patients undergoing THA. First, what was the linear and volumetric wear rate of HXLPE in patients 50 years or younger at a minimum followup of 9 years and was osteolysis observed in any of these hips? Given the potential for damage to the Oxinium femoral head surface, was the wear of HXLPE in the patients with this material similar to the other bearings or was there accelerated or runaway wear that was visible in any of the patients? </p> </div><div class="section"> <a class="named-anchor" id="d13716497e134"> <!-- named anchor --> </a> <h5 class="section-title" id="d13716497e135">Methods</h5> <p id="d13716497e137">From November 1999 to April 2005, 105 THAs were performed in 95 patients 50 years of age or younger (mean, 42 years; range, 20–50 years). The mean body mass index was 30 kg/m <sup>2</sup> (range, 17–51 kg/m <sup>2</sup>).The mean followup was 12 years (range, 9–14 years). Two patients died, five patients (one bilateral) were lost to followup, and one hip was revised elsewhere for pain. The patients’ information was not included in the study, which left 87 patients with 96 hips for analysis. Highly crosslinked polyethylene was the acetabular bearing for all of the hips. We analyzed the linear and volumetric wear of all of the hips using the Martell method. Eighty hips had the same diameter head (28 mm) allowing us to more accurately compare the different bearing materials. The type of femoral head used was related to our sequential use of materials beginning with cobalt chrome (14), ceramic (23) followed by Oxinium (43) in the hips with 28-mm heads. Although cobalt-chrome was used early in this study, our previous experience with ceramic on polyethylene encouraged us to use it as an alternative bearing. The Oxinium was used consecutively for the remaining hips. </p> </div><div class="section"> <a class="named-anchor" id="d13716497e145"> <!-- named anchor --> </a> <h5 class="section-title" id="d13716497e146">Results</h5> <p id="d13716497e148">The mean wear of the HXLPE after 1 year of bedding-in (true linear wear)was 0.022 mm/year (95% confidence interval [CI], 0.015–0.030 mm/year). The mean volumetric wear of HXLPE after 1 year of bedding-in (true volumetric wear) was 9 mm <sup>3</sup>/year (95% CI, 4–14 mm <sup>3</sup>/year). None of the hip radiographs had evidence of loosening or osteolysis. Wear was not associated with femoral head material (p = 0.58 for linear wear/year versus head material and p = 0.52 for volumetric wear/year versus head material). </p> </div><div class="section"> <a class="named-anchor" id="d13716497e156"> <!-- named anchor --> </a> <h5 class="section-title" id="d13716497e157">Conclusions</h5> <p id="d13716497e159">In our study of patients 50 years of age or younger undergoing THA, the linear and volumetric wear rates of HXLPE were very low regardless of the bearing surface material. The laboratory concerns of Oxinium surface damage are serious but at this time we have not seen high wear of the HXLPE or osteolysis in this population. </p> </div><div class="section"> <a class="named-anchor" id="d13716497e161"> <!-- named anchor --> </a> <h5 class="section-title" id="d13716497e162">Level of Evidence</h5> <p id="d13716497e164">Level III, therapeutic study.</p> </div>

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          Most cited references36

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          Radiological Demarcation of Cemented Sockets in Total Hip Replacement

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            A prospective, randomized study of cross-linked and non-cross-linked polyethylene for total hip arthroplasty at 10-year follow-up.

            In 1999, our institution initiated a prospective study to compare the outcome of total hip arthroplasty patients randomized to either non-cross-linked liners or polyethylene liners that were cross-linked with 5.0 Mrad of gamma-irradiation and heat treated to eliminate free radicals. Among 230 randomized THAs, 13 have had reoperations, and 31 patients with 32 THAs died with less than 9-year follow-up. Follow-up for the remaining 185 THAs averaged 10.0 ± 1.8 years. There have been 9 wear-related liner exchanges among the non-cross-linked group and none among the cross-linked group. Using revision for wear-related complications as an endpoint, survivorship at 10-years was 94.7 ± 4.6% for non-cross-linked and 100% for cross-linked (P = .003). Among unrevised hips, the mean linear wear rate was 0.22 mm/yr for non-cross-linked and 0.04 mm/yr for cross-linked (P < .001). The incidence of clinically important osteolysis with an area of at least 1.5 square centimeters among unrevised hips was 22% for non-cross-linked and 0% for cross-linked (P < .001). Copyright © 2012 Elsevier Inc. All rights reserved.
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              The John Charnley Award: Highly crosslinked polyethylene in total hip arthroplasty decreases long-term wear: a double-blind randomized trial.

              The use of highly crosslinked polyethylene (HXLPE) is now commonplace for total hip arthroplasty. Hip simulator studies and short-term in vivo measurements suggest that the wear rate of some types of HXLPE is significantly less than conventional ultrahigh-molecular-weight polyethylene (UHMWPE). However, there are few long-term data to support its use.
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                Author and article information

                Journal
                Clinical Orthopaedics and Related Research®
                Clin Orthop Relat Res
                Springer Nature America, Inc
                0009-921X
                1528-1132
                December 2015
                June 30 2015
                December 2015
                : 473
                : 12
                : 3829-3835
                Article
                10.1007/s11999-015-4422-7
                4626518
                26122983
                c7addf6d-dc61-4f4e-bec8-c279fe9e4ef1
                © 2015
                History

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