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Nishimura M, Nakamura T, Nishida H, Misaki T, Aikawa T. In Vivo Oxidation and Wear in Remelted Highly Cross-Linked Polyethylene Liners Retrieved at a Minimum of 10 Years After Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00632-6. [PMID: 38909854 DOI: 10.1016/j.arth.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND With the decreasing age threshold for patients undergoing total hip arthroplasty (THA), there is an escalating demand for enhanced polyethylene durability. Although reports assessing wear in remelted highly cross-linked polyethylene (HXLPE) through radiographic imaging exist, a consensus regarding its oxidation level is lacking. This study investigated the wear, oxidation levels, and degradation of remelted HXLPE that was retrieved at least 10 years after THA. METHODS Our analysis focused on 7 cases of melted HXLPE liners retrieved ≥10 years after THA. All patients were women, who had an average age of 64 ± 6.5 years at the initial operation, and the mean postoperative period after THA was 12 years and 11 months ±1 year and 5 months. The wear conditions were measured by matching the shape analysis data obtained from a coordinate-measuring machine with a spherical model. Fourier-transform infrared spectroscopy was used to study the oxidation of polyethylene, and the polyethylene structure was evaluated using scanning electron microscopy. RESULTS Osteolysis was not observed in any case on X-rays, computed tomography, or intraoperative findings during revision surgery. The average oxidation index (OI) of the sliding surface under load was 0.31 ± 0.22 in the 6 cases calculated after hexane treatment, and 0.69 for one case without hexane treatment. In the 6 cases calculated after hexane treatment, the average OI of the non-load-bearing sliding surface was 0.11 ± 0.20. Average wear values were 0.33 ± 0.11 mm at 45 degrees from the equatorial direction and 0.04 ± 0.07 mm in the opposite direction. The initial structure of the polyethylene was preserved at all sites with low oxidation levels; however, in one case with stem subsidence, morphological changes and a high OI were observed. CONCLUSIONS Long-term oxidation and wear of remelted HXLPE liners retrieved from THA patients were minimal.
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Affiliation(s)
- Manase Nishimura
- Department of Orthopaedic Surgery, Toyama Nishi General Hospital, Toyama, Japan
| | - Takuya Nakamura
- Department of Orthopaedic Surgery, Toyama Nishi General Hospital, Toyama, Japan
| | - Hideji Nishida
- Department of Orthopaedic Surgery, Toyama Nishi General Hospital, Toyama, Japan
| | - Tomonori Misaki
- Department of Orthopaedic Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Takao Aikawa
- Department of Orthopaedic Surgery, Toyama Prefecture Central Hospital, Toyama, Japan
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Deans CF, Buckner BC, Garvin KL. Wear, Osteolysis, and Aseptic Loosening Following Total Hip Arthroplasty in Young Patients with Highly Cross-Linked Polyethylene: A Review of Studies with a Follow-Up of over 15 Years. J Clin Med 2023; 12:6615. [PMID: 37892754 PMCID: PMC10607435 DOI: 10.3390/jcm12206615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Total hip arthroplasty (THA) has in recent years trended toward a younger, more physically demanding patient population. Mid- to long-term studies of all ages of THA patients using highly cross-linked polyethylene (HXLPE) have been favorable, but concerns about its long-term failure and wear-related complications remain for young THA patients. In this narrative review, a search of the PubMed/MEDLINE and Cochrane databases was performed, and we identified six studies with a minimum 15-year follow-up of HXLPE with various femoral head materials. Wear-related revisions were exceedingly low for patients under the age of 55, with variable reports of non-clinically significant osteolysis. Higher activity levels, a larger femoral head size, and femoral head material were not associated with greater long-term wear rates. Young THA with metal or ceramic on HXLPE is exceedingly durable with favorable outcomes at follow-ups of over 15 years.
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Affiliation(s)
| | | | - Kevin L. Garvin
- Department of Orthopaedic Surgery & Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA
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Langlois J, Hamadouche M. What have we learned from 20 years of using highly crosslinked PE in total hip arthroplasty? Orthop Traumatol Surg Res 2023; 109:103457. [PMID: 36302450 DOI: 10.1016/j.otsr.2022.103457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/07/2022]
Abstract
Slightly more than 20 years after its first clinical use, highly cross-linked polyethylene (HXLPE) has been widely adopted. Despite initial concerns about oxidation and lack of fatigue resistance, first generation HXLPE, with 15 years of follow-up and widespread use, continues to provide excellent results, even in a young, active population. Remelted HXLPE might have a lower wear rate than annealed HXLPE and will no doubt have a better resistance to oxidation. Second generation materials, consisting of polyethylene (PE) that is sequentially irradiated then annealed and PE that is infused with antioxidants, also have provided encouraging short- and medium-term results. Data from national joint registers confirm data from clinical trials. Even in more challenging cases (dual mobility, hip resurfacing, revision surgery and thin liners), HXLPE has generated promising results. However, failures (rim fractures) have been documented, including for all the latest HXLPE generations. Consequently, certain precautions must be taken during its use and close patient monitoring is necessary.
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Affiliation(s)
- Jean Langlois
- Centre Orthopédique Santy, 24, avenue Paul Santy, Lyon, France; Hôpital Privé Jean-Mermoz, 55, avenue Jean-Mermoz, Lyon, France.
| | - Moussa Hamadouche
- Département de Chirurgie Orthopédique, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, Paris, France
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García-Rey E, Cruz-Pardos A, Saldaña L. New polyethylenes in total hip arthroplasty : a 20- to 22-year follow-up study. Bone Joint J 2022; 104-B:1032-1038. [PMID: 36047028 DOI: 10.1302/0301-620x.104b9.bjj-2022-0434.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS A significant reduction in wear at five and ten years was previously reported when comparing Durasul highly cross-linked polyethylene with nitrogen-sterilized Sulene polyethylene in total hip arthroplasty (THA). We investigated whether the improvement observed at the earlier follow-up continued, resulting in decreased osteolysis and revision surgery rates over the second decade. METHODS Between January 1999 and December 2001, 90 patients underwent surgery using the same acetabular and femoral components with a 28 mm metallic femoral head and either a Durasul or Sulene liner. A total of 66 hips of this prospective randomized study were available for a minimum follow-up of 20 years. The linear femoral head penetration rate was measured at six weeks, one year, and annually thereafter, using the Dorr method on digitized radiographs with a software package. RESULTS In the Durasul group, no patients underwent revision due to loosening or showed radiological evidence of osteolysis. In the Sulene group, four patients (four hips) were revised due to femoral component loosening. The 20-year cumulative failure incidence in the presence of the competing event of death for revision surgery was 4.5% (95% confidence interval (CI) 0.8 to 13.6) in the Durasul group, and 8.9% (95% CI 2.8 to 19.5) in the Sulene group. The mean wear one year after surgery was 0.09 mm (SD 0.007) in the Durasul group and 0.24 (SD 0.015) in the Sulene group (p < 0.001). From one to 20 years after surgery, the mean total penetration was 0.32 mm (SD 0.045) in the Durasul group and 1.07 mm (SD 0.13) in the Sulene group (p < 0.001). Mean femoral head penetration at 20 years was approximately 70.0% less in the Durasul group than the Sulene group. CONCLUSION The significant reduction in femoral head penetration obtained with the Durasul compared with Sulene in uncemented THA resulted in lower osteolysis and revision rates after 20 years.Cite this article: Bone Joint J 2022;104-B(9):1032-1038.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain.,Bioengineering, Biomaterials and Nanomedicine, Biomedical Research Networking Center, Madrid, Spain
| | - Ana Cruz-Pardos
- Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
| | - Laura Saldaña
- Bioengineering, Biomaterials and Nanomedicine, Biomedical Research Networking Center, Madrid, Spain.,Bone Pathophysiology and Biomaterials Group, Hospital Universitario La Paz-Idi Paz, Madrid, Spain
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Sheridan GA, Clesham K, Garbuz DS, Masri BA. Highly cross-linked polyethylene (HXLPE) is equivalent to conventional polyethylene (CPE) in total knee arthroplasty: A systematic review and meta-analysis. Knee 2021; 33:318-326. [PMID: 34741831 DOI: 10.1016/j.knee.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/20/2021] [Accepted: 10/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The benefits of HXLPE in total knee arthroplasty (TKA) have not been as evident as total hip arthroplasty (THA). A systematic review and meta-analysis to assess the impact of highly-crosslinked polyethylene (HXLPE) on TKA outcomes compared to conventional polyethylene (CPE) is described. METHODS All studies comparing HXLPE with CPE for primary TKA were included for analysis. The minimum dataset included revision rates, indication for revision, aseptic component loosening and follow-up time. The primary outcome variables were all-cause revision, aseptic revision, revision for loosening, radiographic component loosening, osteolysis and incidence of radiolucent lines. Secondary outcome measures included postoperative functional knee scores. A random-effects meta-analysis allowing for all missing data was performed for all primary outcome variables. RESULTS Six studies met the inclusion criteria. In total, there were 2,234 knees (1,105 HXLPE and 1,129 CPE). The combined mean follow-up for all studies was 6 years. The aseptic revision rate in the HXLPE group was 1.02% compared to 1.97% in the CPE group. There was no difference in the rate of all-cause revision (p = 0.131), aseptic revision (p = 0.298) or revision for component loosening (p = 0.206) between the two groups. Radiographic loosening (p = 0.200), radiolucent lines (p = 0.123) and osteolysis (p = 0.604) was similar between both groups. Functional outcomes were similar between groups. CONCLUSION The use of HXLPE in TKA yields similar results for clinical and radiographic outcomes when compared to CPE at midterm follow-up. HXLPE does not confer the same advantages to TKA as seen in THA.
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Affiliation(s)
- G A Sheridan
- Department of Orthopedic Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 3rd Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - K Clesham
- Department of Orthopedic Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 3rd Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - D S Garbuz
- Department of Orthopedic Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 3rd Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - B A Masri
- Department of Orthopedic Surgery, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, 3rd Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
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Wear analysis of the first-generation cross-linked polyethylene at minimum 10 years follow-up after THA: no significant effect of sports participation. J Artif Organs 2021; 25:140-147. [PMID: 34708284 DOI: 10.1007/s10047-021-01297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
The impact of sports on long-term wear of highly cross-linked polyethylene (XLPE) after total hip arthroplasty (THA) is not fully understood. We investigated (1) the wear performance of the first-generation XLPE, and (2) whether sports participation influences the steady wear rate of XLPE. The femoral head penetration into the cup was measured digitally on radiographs of hips undergoing THA with XLPE. We retrospectively reviewed data that included age, gender, body mass index, follow-up period, preoperative diagnosis, types of XLPE, ball diameter, head material, inclination of the cup, physical function score, and sports participation. Statistical analyses were applied to determine whether sports affect the wear of XLPE and which factors were associated with the steady wear rate. Creep and steady wear rate were found to be 0.18 mm and 0.005 mm/year, respectively. Sports participation, regardless of impact, provided no significant difference in the steady wear rate. Multiple regression analysis demonstrated that sports did not increase the steady wear rate. Our findings showed excellent wear performance of the first-generation XLPE at a minimum of ten years after THA, without significant effect of sports participation on the liner wear.
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Roedel GG, Kildow BJ, Sveom DS, Garvin KL. Total hip arthroplasty using highly cross-linked polyethylene in patients aged 50 years and younger : minimum 15-year follow-up. Bone Joint J 2021; 103-B:78-83. [PMID: 34192900 DOI: 10.1302/0301-620x.103b7.bjj-2020-2443.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Highly cross-linked polyethylene (HXLPE) has greatly improved the durability of total hip arthroplasty (THA) in young patients because of its improved wear characteristics. Few studies have followed this population into the second decade, and therefore the purpose of this investigation was to evaluate the clinical outcome for THA patients 50 years of age and younger at a minimum of 15 years postoperatively. The second purpose was to evaluate the radiological findings secondary to wear or mechanical failure of the implant. METHODS Between October 1999 and December 2005, 105 THAs were performed in 95 patients (53 female, 42 male) aged 50 years and younger (mean 42 years (20 to 50)). There were 87 patients (96 hips) that were followed for a minimum of 15 years (mean 17.3 years (15 to 21)) for analysis. Posterior approach was used with cementless fixation with a median head size of 28 mm. HXLPE was the acetabular bearing for all hips. Radiographs were evaluated for polyethylene wear, radiolucent lines, and osteolysis. RESULTS Clinical outcomes showed significant improvement of mean Harris Hip Scores from 52.8 (SD 13.5) preoperatively to 94.8 (SD 7.6) postoperatively. One hip was revised for recurrent instability, and there were no infections. No hips were revised for mechanical loosening or osteolysis. Mean polyethylene linear wear was 0.04 mm/year and volumetric wear was 6.22 mm3/year, with no significant differences between head size or material. Osteolysis was not present in any of the hips. CONCLUSION The use of HXLPE in THA for patients aged 50 years and younger has performed exceptionally well without evidence of significant wear causing mechanical loosening or necessitating revision. The radiolucent lines of the acetabular component must be followed to determine the prognostic significance. This investigation represents the longest clinical follow-up of a large, consecutive cohort of patients aged 50 years or younger with THA using HXLPE. This long-term analysis found negligible polyethylene wear, no incidence of aseptic loosening, and excellent clinical outcomes at and beyond 15 years of follow-up. Cite this article: Bone Joint J 2021;103-B(7 Supple B):78-83.
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Affiliation(s)
- Gordon G Roedel
- Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Beau J Kildow
- Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel S Sveom
- Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kevin L Garvin
- Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Affiliation(s)
- Mengnai Li
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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Langlois J, Hamadouche M. Recent update on crosslinked polyethylene in total hip arthroplasty. SICOT J 2020; 6:13. [PMID: 32412408 PMCID: PMC7227368 DOI: 10.1051/sicotj/2020013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023] Open
Abstract
More than two decades after their clinical introduction, crosslinked polyethylenes (XLPE) have been widely adopted. Though concerns were initially raised regarding oxidation and brittleness, on a large scale, the first generation of XLPE continues to be highly effective 15 years after the surgery, even in a young and active population. Remelted XLPE might display lower wear rates than annealed XLPE. Second generation XLPEs, not only including sequentially irradiated and annealed but also associated with antioxidants, demonstrate encouraging short- to mid-term results. Registry data support clinical trial reports. Even in less favorable settings (lipped liners, dual mobility cups, revision surgery, hip resurfacing) results are promising. However, failures (fractures) have already been described. Therefore, a high level of surveillance remains crucial.
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Affiliation(s)
- Jean Langlois
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Centre Orthopédique Santy 24, avenue Paul Santy 69008 Lyon France
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Hôpital Privé Jean-Mermoz 55, avenue Jean-Mermoz 69008 Lyon France
| | - Moussa Hamadouche
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Département de Chirurgie Orthopédique, Université Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin 27, rue du Faubourg Saint-Jacques 75014 Paris France
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