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Thalody HS, Ponzio DY, Santoro AJ, Radack TM, Post ZD, Ong AC. Large Femoral Heads With Small Acetabular Components: An Examination of 10-Year Polyethylene Wear. Orthopedics 2024; 47:118-122. [PMID: 37561101 DOI: 10.3928/01477447-20230804-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Highly cross-linked polyethylene (HXLPE) has improved polyethylene (PE) wear rates while decreasing osteolysis and aseptic loosening. However, concerns exist regarding the risk of mechanical failure with thin HXLPE liners in total hip arthroplasty (THA). Our purpose was to evaluate long-term outcomes and PE wear rates in primary THAs pairing large femoral heads with small acetabular components and thin HXLPE liners. We retrospectively reviewed 29 patients who underwent 33 primary THAs using large femoral heads (32 or 36 mm) with small acetabular components (48 or 50 mm) and thin HXLPE liners (3.9 or 5.9 mm) at minimum 10-year follow-up. PE liner wear was measured using a validated radiographic technique. Mean age was 66 years, 97% of the patients were women, and mean body mass index was 26.3 kg/m2. Thirty hips (90.9%) had ceramic femoral heads, and 13 hips (39%) had 36-mm femoral heads with 3.9-mm HXLPE liners. All cases used a neutral PE design. Mean linear wear rate and volumetric wear rate were 0.04 mm/year and 39.6 mm3/year, respectively, at mean 10.9-year follow-up. There were no instances of liner fracture, liner dissociation, or revision. Mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) was 92.1. In the largest long-term study of primary THAs using large femoral heads with small acetabular components and thin HXLPE liners, we found low linear and volumetric wear rates and no cases of liner mechanical failures. Thin HXLPE liners are a safe and viable option for THA surgeons. [Orthopedics. 2024;47(2):118-122.].
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Hasegawa M, Tone S, Naito Y, Sudo A. Ultra-High-Molecular-Weight Polyethylene in Hip and Knee Arthroplasties. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2140. [PMID: 36984020 PMCID: PMC10054334 DOI: 10.3390/ma16062140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Ultra-high-molecular-weight polyethylene (UHMWPE) wear and particle-induced osteolysis contribute to the failure of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Highly crosslinked polyethylene (HXLPE) was developed in the late 1990s to reduce wear and has shown lower wear rates and loosening than conventional UHMWPE in THA. The irradiation dose for crosslinking is up to 100 kGy. However, during crosslinking, free radical formation induces oxidation. Using HXLPE in THA, the cumulative revision rate was determined to be significantly lower (6.2%) than that with conventional UHMWPE (11.7%) at a mean follow-up of 16 years, according to the Australian Orthopaedic Association National Joint Replacement Registry. However, HXLPE does not confer to TKA the same advantages it confers to THA. Several alternatives have been developed to prevent the release of free radicals and improve polymer mechanical properties, such as thermal treatment, phospholipid polymer 2-methacryloyloxyethyl phosphorylcholine grafting, remelting, and vitamin E addition. Among these options, vitamin E addition has reported good clinical results and wear resistance similar to that of HXLPE without vitamin E, as shown by short-term clinical studies of THA and TKA. This review aims to provide a comprehensive overview of the development and performance of UHMWPE in THA and TKA.
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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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Kump J, Teeter MG, Matheson J, Klassen R, Lanting BA, Decker MM. The impact of free-radical stabilization techniques on in vivo subsurface mechanical properties in highly cross-linked polyethylene acetabular liners. J Orthop Res 2023. [PMID: 36601654 DOI: 10.1002/jor.25502] [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: 03/06/2022] [Revised: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023]
Abstract
Highly cross-linked polyethylene (HXLPE) for total hip arthroplasty was developed to improve wear resistance in vivo and associated complications in comparison to ultrahigh molecular weight polyethylene. This material typically goes through various free-radical stabilization techniques by remelting, single-annealing, or sequentially annealing the polyethylene to improve in vivo oxidation and wear properties. The purpose of this study is to determine if there is evidence of subsurface microhardness changes in retrieved HXLPE liner at the rim and articular subsurface after extended in vivo time that could be associated with oxidation and its effects on mechanical properties and implant integrity. Retrieved HXLPE liners were chosen based on peak subsurface Fourier transform infrared spectroscopy oxidation values. Each was mechanically tested for subsurface microhardness at both the rim and articular surface using a validated microindentation technique. Rim testing demonstrated a decrease in mechanical integrity that corresponded to higher subsurface oxidation values regardless of the free-radical stabilization technique. At the articular surface, a decrease in mechanical integrity was observed near the surface corresponding to peak oxidation and Vicker's hardness, which decreased with increasing depths. This was found in all groups, with the exception of the single-annealed liners, which demonstrated decreased mechanical integrity trends at greater depths between 1.0 and 2.0 mm. Our results suggest that subsurface mechanical properties do change in vivo for certain implants. Though it is likely that the mechanical failures are multifactorial, we have shown that mechanical property degradation of HXLPE liners does occur with long-term in vivo exposure and should be considered a possible risk factor.
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Affiliation(s)
- Jordan Kump
- Department of Orthopaedic Surgery, The University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, London, Canada.,Western University, Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, London, Ontario, Canada.,Surgical Innovation Program, Lawson Health Research Institute, London, Canada.,Division of Orthopaedic Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - John Matheson
- Division of Orthopaedic Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Robert Klassen
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Michael M Decker
- Department of Orthopaedic Surgery, The University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
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Fransen BL, Bengoa FJ, Neufeld ME, Sheridan GA, Garbuz DS, Howard LC. Thin highly cross-linked polyethylene liners combined with large femoral heads in primary total hip arthroplasty show excellent survival and low wear rates at a mean follow-up of 12.8 years. Bone Joint J 2023; 105-B:29-34. [PMID: 36587249 DOI: 10.1302/0301-620x.105b1.bjj-2022-0812.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: 01/02/2023]
Abstract
AIMS Several short- and mid-term studies have shown minimal liner wear of highly cross-linked polyethylene (HXLPE) in total hip arthroplasty (THA), but the safety of using thinner HXLPE liners to maximize femoral head size remains uncertain. The objective of this study was to analyze clinical survival and radiological wear rates of patients with HXLPE liners, a 36 mm femoral head, and a small acetabular component with a minimum of ten years' follow-up. METHODS We retrospectively identified 55 patients who underwent primary THA performed at a single centre, using HXLPE liners with 36 mm cobalt-chrome heads in acetabular components with an outer diameter of 52 mm or smaller. Patient demographic details, implant details, death, and all-cause revisions were recorded. Cox regression and Kaplan-Meier survival was used to determine all-cause and liner-specific revision. Of these 55 patients, 22 had a minimum radiological follow-up of seven years and were assessed radiologically for linear and volumetric wear. RESULTS Overall survival rate for all-cause revision was 94.5% (95% confidence interval (CI) 81.7% to 97.2%) at a mean follow-up of 12.8 years (10.9 to 18.7). Three patients were revised, none for liner wear, fracture, or dissociation. A total of 22 patients were included in the radiological analysis (mean follow-up 9.9 years (7.5 to 13.7)). Mean linear liner wear was 0.085 mm (95% CI -0.086 to 0.257) and the volumetric wear rate was 11.097 mm3/year (95% CI -6.5 to 28.7). CONCLUSION Using HXLPE liners with 36 mm heads in 52 mm acetabular components or smaller is safe, with excellent survival and low rates of linear and volumetric wear at medium-term follow-up. Patients did not require revision surgery for liner complications such as fracture, dissociation, or wear. Our results suggest that the advantages of using larger heads outweigh the potential risks of using thin HXLPE liners.Cite this article: Bone Joint J 2023;105-B(1):29-34.
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Affiliation(s)
- Bas L Fransen
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Francisco J Bengoa
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Michael E Neufeld
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Gerard A Sheridan
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Donald S Garbuz
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Lisa C Howard
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
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Beckert M, Meneghini RM, Meding JB. Instability After Primary Total Hip Arthroplasty: Dual Mobility Versus Jumbo Femoral Heads. J Arthroplasty 2022; 37:S571-S576. [PMID: 35271976 DOI: 10.1016/j.arth.2022.02.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of dual mobility (DM) articulations has grown substantially over the last decade to help minimize dislocation risk. The purpose of this study is to compare the results of DM articulations to jumbo femoral heads of equivalent sizes as they relate to postoperative dislocation. METHODS This is a retrospective cohort study of primary total hip arthroplasties (THAs) performed at a single institution between 2005 and 2018. DM articulations and large-diameter metal-on-metal femoral heads were included. Patients were followed with Harris Hip Scores and standard radiographs. Complications were prospectively recorded. Statistical analyses included chi-squared and Brown-Forsythe tests. RESULTS In total, 1,288 Magnum femoral head THAs and 365 Active Articulation DM THAs were included for analysis. The same monoblock cup was implanted via a posterior approach in all cases. Age, gender, body mass index, and diagnosis were similar between groups. Average follow-up in the DM group was 49 months, and 126 months in the jumbo head group. The average head sizes in the DM and jumbo head groups were 50 mm. There were no dislocations in the DM hips and only 2 (0.2%) in the jumbo femoral head group. Both groups had significant improvements in Harris Hip Score from their preoperative baseline. CONCLUSION Our study found similarly low dislocation rates in DM and jumbo femoral heads in primary THA. No evidence currently exists showing a benefit of the DM articulation beyond that of the large effective head size, and we recommend making every attempt at maximizing head size prior to using DM articulations.
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Affiliation(s)
- Mitchell Beckert
- The Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; The IU Hip and Knee Center, Fishers, IN
| | - R Michael Meneghini
- The Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; The IU Hip and Knee Center, Fishers, IN
| | - John B Meding
- The Center for Hip and Knee Surgery, St. Francis Hospital Mooresville, Mooresville, IN
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Pairing 40-mm Femoral Heads With the Smallest Compatible Acetabular Components in Total Hip Arthroplasty: Mid-Term Outcomes in 177 Cases. J Arthroplasty 2022; 37:S582-S587. [PMID: 35256235 DOI: 10.1016/j.arth.2022.01.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Contemporary total hip arthroplasty (THA) often employs larger femoral heads to optimize hip stability. However, pairing 40-mm femoral heads with the smallest compatible acetabular components poses a potential risk for implant failure. The purpose of this study is to evaluate the outcomes of primary THAs using 40-mm femoral heads and the smallest compatible acetabular components. METHODS Between 2007 and 2018, 177 primary THAs involving 40-mm femoral heads and acetabular components ≤56 mm with highly cross-linked polyethylene liners were identified. Mean age was 61 years, 56% were females, and mean body mass index was 32 kg/m2. Cumulative incidences of dislocation, any revision, and any reoperation were determined utilizing a competing risk model. Osteolysis and femoral head penetration were assessed at minimum 8-year follow-up (n = 16). Mean follow-up was 6 years. RESULTS There were no cases of liner fractures or dissociations. The 10-year cumulative incidences of dislocation, any revision, and any reoperation were 3.6%, 4.2%, and 6.8%, respectively. Mean linear femoral head penetration was 0.01 mm/y and mean volumetric wear rate was 50 mm3/y. One THA demonstrated stable, asymptomatic periacetabular radiolucent lines at most recent follow-up. CONCLUSION In 177 primary THAs pairing 40-mm femoral heads with the smallest compatible acetabular components, there were no liner fractures or dissociations. The cumulative incidence of dislocation was modest at 10 years. The cumulative incidences of any revision and any reoperation were low at mid-term. LEVEL OF EVIDENCE IV.
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8
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Decker M, Price A, Khalili A, Klassen R, Walzak MJ, Teeter M, McCalden R, Lanting B. The Impact of Free Radical Stabilization Techniques on in vivo Mechanical Changes in Highly Cross-Linked Polyethylene Acetabular Liners. Orthop Res Rev 2021; 13:113-122. [PMID: 34429667 PMCID: PMC8380133 DOI: 10.2147/orr.s309210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/22/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Numerous thermal free radical stabilization techniques are used in the production of highly cross-linked polyethylene (HXLPE) to improve oxidative stability. Little knowledge exists on the effects of in vivo time on the mechanical properties of HXLPE. The purpose of this study was to determine if free radical stabilization of HXLPE impacts mechanical properties as well as oxidative stability of acetabular liner rims after extended in vivo time. Methods Retrieved and control remelted, single annealed and sequentially annealed HXLPE liner rims were tested for mechanical properties. Oxidation was measured with FTIR spectroscopy and crystalline phase composition measured with Raman spectroscopy. Results No correlation was found between in vivo, ex vivo time and hardness for annealed groups. A statistically significant difference in hardness was identified between free radical stabilization groups. No correlation between maximum rim oxidation and in vivo time was found. Detectable levels of rim oxidation were present in 100% of single annealed, 75% of sequentially annealed, and 25% of remelted retrieved liners. Single and sequentially annealed liners demonstrated oxidation and increased crystallinity. Rim mechanical properties change in vivo for implant types. With in vivo time, retrieved remelted HXLPE demonstrated decreased mechanical properties, whereas retrieved single and sequentially annealed HXLPE properties remained stable. All liner cohorts demonstrated evidence of rim oxidation. Subsequent changes in crystallinity were only observed in oxidized annealed liners. Conclusion HXLPE acetabular liner rims show evidence of in vivo mechanical property degradation, notably in remelted HXLPE, which may be a risk factor in rim fracture and catastrophic implant failure.
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Affiliation(s)
- Michael Decker
- Department of Orthopaedic Surgery, The University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
| | - Amber Price
- Department of Orthopaedic Surgery, The University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
| | - Aria Khalili
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Robert Klassen
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Mary Jane Walzak
- Surface Science Western, University of Western Ontario, London, Ontario, Canada
| | - Matthew Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry.,Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry.,Surgical Innovation Program, Lawson Health Research Institute.,Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Richard McCalden
- Division of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
| | - Brent Lanting
- Division of Orthopaedic Surgery, London Health Sciences Centre, University Hospital, London, Ontario, Canada
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Díaz-Dilernia F, Lattore M, Zanotti G, Comba F, Piccaluga F, Buttaro M. Gait instability may indicate liner failure in patients with total hip arthroplasty. A report of three cases. Ann R Coll Surg Engl 2021; 103:e298-e304. [PMID: 34414774 DOI: 10.1308/rcsann.2021.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Total hip arthroplasty is one of the most common and successful orthopaedic procedures performed worldwide. Uncemented modular acetabular components and highly cross-linked polyethylene liners are the implants of choice for most arthroplasty surgeons. However, despite their well-known benefits, highly cross-linked polyethylene liners are not without complications, such as rim fracture, rupture and dissociation. We report three patients with gait instability and radiographic subluxation due to highly cross-linked polyethylene liner failures evidenced during stage one revision surgery. The three patients were symptoms free, with no new instability episodes, and the radiographs showed no evidence of implant loosening at the most recent follow-up. Although it is a rare complication, these three cases highlight the importance of suspecting and evaluating highly cross-linked polyethylene liner failures in patients referred for gait instability with no history of previous trauma.
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Affiliation(s)
| | - M Lattore
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - G Zanotti
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Comba
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Piccaluga
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - M Buttaro
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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10
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Baker CE, Bukowski BR, Abdel MP, Trousdale RT. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Using Big Heads and Small Acetabular Components With Highly Cross-Linked Polyethylene in Total Hip Arthroplasty: Is It Safe? J Arthroplasty 2021; 36:S11-S17. [PMID: 33622530 DOI: 10.1016/j.arth.2021.01.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/06/2021] [Accepted: 01/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Contemporary total hip arthroplasty (THA) employs larger femoral heads to optimize hip stability. However, the combination of large femoral heads and comparatively small acetabular components poses a potential risk for implant failure secondary to polyethylene (PE) liner fracture or dissociation. The purpose of this study was to evaluate the incidence of liner fracture or dissociation, implant survivorship, and PE wear rates in primary THAs using large femoral heads and small acetabular components. METHODS Between 2000 and 2017, we retrospectively identified 882 primary THAs with 36 mm femoral heads and acetabular components ≤52 mm with highly cross-linked polyethylene liners. Mean age was 66 years, 88% were females, and mean body mass index was 30 kg/m2. We evaluated the cumulative incidences of dislocation, any revision, and any reoperation utilizing a competing risk model. Osteolysis and femoral head penetration were assessed with a validated radiographic technique at minimum 10-year follow-up (n = 18). Mean follow-up was 4 years. RESULTS There were no liner fractures or dissociations in the entire cohort. The 10-year cumulative incidences of dislocation, any revision, and any reoperation were 3.2%, 5.6%, and 9.3%, respectively. Mean linear femoral head penetration was 0.042 mm/y and mean volumetric wear rate was 44 mm3/y. No THAs demonstrated evidence of osteolysis or component loosening at long-term follow-up. CONCLUSION In a large cohort of primary THAs pairing large femoral heads with small acetabular components, there was no evidence of liner fracture or dissociation. Cumulative incidences of dislocation, any revision, and any reoperation were low at mid-term. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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11
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Abstract
INTRODUCTION Recent advances in polyethylene and ceramic technologies has allowed us to use larger sized heads without compromising the wear properties of a total hip arthroplasty (THA). 1 benefit of this change has been proposed to be a lower incidence of dislocation. METHODS We retrospectively evaluated the dislocation rate in 913 THAs performed using the same standardised surgical technique employed by a single team of surgeons at our institution between 1995 and 2015. Patients were assigned to 2 groups: small (⩽28 mm), large diameter heads (⩾36 mm and larger). The cup position was measured and plotted to determine its status according to the Lewinnek's safe zone (15° ± 10° for anteversion, 40° ± 10° for inclination). RESULTS 16 of the 472 small heads dislocated (3.4%) while 5 of the 441 in large head group (1.1%) (p = 0.04). In all of the large head patients that dislocated the cup position was in the safe range of Lewinnek. However, in the large head group only 64.5% of the cups were in the safe zone. CONCLUSIONS By changing the head size to 36 mm, we were able to decrease the dislocation rate significantly. Errors of cup positioning according to Lewinnek became oblivious when using large heads. In our opinion, using large heads in THA makes a difference in terms of dislocation.
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Affiliation(s)
- Erkan Sabri Ertaş
- Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - A Mazhar Tokgözoğlu
- Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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12
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Abstract
BACKGROUND This study aimed to examine the major reasons for total hip arthroplasty (THA) failure and temporal patterns in THA revisions. METHODS A retrospective chart review was conducted on 535 revisions performed on 444 THAs from January 2010 to May 2019 at our institution. RESULTS The average time to revision THA was 8.51 ± 8.38 years, with 136 cases (30.9%) occurring within 2 years after primary THA. The major mechanisms of failure that resulted in revision surgery were mechanical failure (162, 36.5%), metallosis (95, 21.4%), dislocation or instability (65, 14.6%), periprosthetic fracture (46, 10.4%), infection (44, 9.9%), hematoma or poor wound healing (15, 3.4%), and pain or other (17, 3.8%). CONCLUSION Based on our institutional experience over the past decade, mechanical failure without dislocation, metallosis, dislocation, periprosthetic fracture, and infection are typical reasons patients present for primary THA revision. Revisions within 2 years after primary THA are more likely to be the result of infection and periprosthetic fracture. Mechanical failure is the most common reason for revision THA overall, and mechanical failure and metallosis are more likely to be the reason revision is necessary 2 or more years after primary THA.
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13
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Jalali O, Scudday T, Fickenscher MC, Barnett S, Gorab R. Third-Generation Medium Cross-Linked Polyethylene Demonstrates Very Low Wear in Total Hip Arthroplasty. Arthroplast Today 2020; 6:316-321. [PMID: 32514421 PMCID: PMC7267711 DOI: 10.1016/j.artd.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/21/2020] [Accepted: 04/07/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cross-linked polyethylene (XLPE) liners have shown lower wear rates than conventional polyethylene liners in total hip arthroplasty. The primary aim of our study was to report our most recent analysis of wear rates and clinical outcomes of a third-generation XLPE liner. Secondary aims were to investigate the rate of adverse events related to mechanical failure or oxidation of this liner. Methods A series of 266 total hip arthroplasties using a specific XLPE liner were retrospectively reviewed. Radiographs were examined to determine linear and volumetric wear rates and presence of osteolysis. Clinical outcomes, revision rates, mechanical failures, and risk factors for accelerated polyethylene wear were additionally investigated. Results The mean age at the time of surgery was 65.8 years and the mean follow-up was 5.5 years. The mean linear wear rate was 0.003 mm/year and the mean volumetric wear rate was 0.42 mm3/year, and there was no evidence of osteolysis. Harris hip scores increased from 50.9 preoperatively to 96.0 at the latest follow-up. The revision rate was 0.4%, with no liner rim fractures and no liner dissociations/loosenings. Femoral head material, head size, age, body mass index, and time since implantation had no effect on wear rates. Conclusion Wear rates for this third-generation XLPE liner were low at mid-term follow-up, and no adverse sequelae of oxidation or deleterious mechanical properties were observed. This remained true regardless of femoral head size and material or patient age and body mass index. Further analysis will be necessary to ensure continued wear resistance, oxidative stability, and mechanical strength at long-term follow-up.
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Affiliation(s)
- Omid Jalali
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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14
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Jonker RC, van Beers LWAH, van der Wal BCH, Vogely HC, Parratte S, Castelein RM, Poolman RW. Can dual mobility cups prevent dislocation without increasing revision rates in primary total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res 2020; 106:509-517. [PMID: 32278733 DOI: 10.1016/j.otsr.2019.12.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dislocation is one of the leading causes for early revision surgery after total hip arthroplasty (THA). To address this problem, the dual mobility (DM) cup was developed in the 1970s by the French. Despite the increased and, in some countries, broad use of DM cups, high quality evidence of their effectiveness compared to traditional unipolar (UP) cups is lacking. There are a few well-conducted literature reviews, but the level of evidence of the included studies was moderate to low and the rates of revision were not specifically investigated. Therefore, we did a systematic review to investigate whether there is a difference in the rate of dislocations and revisions after primary THA with a DM cup or a UP cup. METHODS We conducted a systematic literature search in PubMed, Embase and Cochrane databases in July 2019. The articles were selected based upon their quality, relevance and measurement of the predictive factor. We used the MINORS criteria to determine the methodological quality of all studies. RESULTS The initial search resulted in 702 citations. After application of the inclusion and exclusion criteria, eight articles met our eligibility criteria and were graded. Included studies were of medium to low methodological quality with a mean score of 14/24 (11-16) points following the MINORS criteria. In the case-control studies, a total of 549 DM cups and 649 UP cups were included. In the registry studies, a total of 5.935 DM cups and 217.362 UP cups were included. In the case-control studies, one (0.2%) dislocation was reported for the DM cups and 46 (7.1%) for the UP cup (p=0.009, IQR=0.00-7.00). Nine (1.6%) revisions, of which zero due to dislocation, were reported for the DM cup and 39 (6.0%), of which 30 due to dislocation, for the UP cup (p=0.046, CI=-16.93-5.73). In the registry studies 161 (2.7%) revisions were reported for the DM cup, of which 14 (8.7%) due to dislocation. For the UP cup, 3.332 (1.5%) revisions were reported (p=0.275, IQR=41.00-866.25), of which 1.093 (32.8%) due to dislocation (p=0.050, IQR=3.50-293.25). CONCLUSION This review suggests lower rates of dislocation and lower rates of revision for dislocation in favor of the DM cups. Concluding, DM cups might be an effective solution to reduce dislocation in primary THA. To evaluate the efficacy of DM cups compared to UP cups, an economic evaluation alongside a randomized controlled trial is needed focusing on patient important endpoints. LEVEL OF EVIDENCE III, systematic review of level III studies.
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Affiliation(s)
- Ragna C Jonker
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Loes W A H van Beers
- Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands
| | - Bart C H van der Wal
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - H Charles Vogely
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Sebastien Parratte
- Department of Orthopedic Surgery and Traumatology, St. Marguerite Hospital Marseille, 270 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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15
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Kamada K, Takahashi Y, Tateiwa T, Shishido T, Masaoka T, Pezzotti G, Yamamoto K. Influence of liner offset and locking mechanism on fatigue durability in highly cross-linked polyethylene total hip prostheses. J Biomed Mater Res B Appl Biomater 2019; 108:1993-2004. [PMID: 31876393 DOI: 10.1002/jbm.b.34540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/03/2019] [Accepted: 12/08/2019] [Indexed: 12/19/2022]
Abstract
Highly cross-linked, ultrahigh molecular weight polyethylene (HXLPE) acetabular liners are inherently associated to a risk of fatigue failure due to femoral neck impingement. Different thicknesses and designs employed with HXLPE liners greatly affect mechanical loading scenario. The purpose of this study was to clarify the influence of liner offset (lateralization) and locking mechanism (presence/absence of anti-rotation tabs in the external surface) on fatigue durability in annealed and vitamin E-blended HXLPE liners with a current commercial design. Each liner tested had six anti-rotation tabs, which were engaged in the 6 of 12 recesses on the metal shell. The remaining six recesses had no direct contact with the liner, where HXLPE was mechanically unsupported by the metal backing. These mated and/or unmated rim regions in the offset (2, 3, 4-mm lateralized) liners were exposed to severe neck impingement until crack propagation was identified. Phase volume percentages (crystalline, amorphous, and intermediate phase contents) of HXLPE liners were compared before and after impingement in order to interpret differences in impingement micromechanics associated with the rim design variations. Our results showed that the presence of unmated recesses served as a stress concentrator due to the formation of millimeter-scale gaps between the liner and shell. Another potential design problem drawn from our study was liner offset associated with a small volume protruding above the metal rim. Therefore, surgeons should take special care in selecting locking designs and geometries especially when using HXLPE offset liners.
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Affiliation(s)
- Kosuke Kamada
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.,Department of Bone and Joint Biomaterial Research, Tokyo Medical University, Tokyo, Japan
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takaaki Shishido
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshinori Masaoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Giuseppe Pezzotti
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan.,Ceramic Physics Laboratory, Kyoto Institute of Technology, Kyoto, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
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16
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Kumar A, Ghosh R, Kumar R. Effects of interfacial crack and implant material on mixed-mode stress intensity factor and prediction of interface failure of cemented acetabular cup. J Biomed Mater Res B Appl Biomater 2019; 108:1844-1856. [PMID: 31769210 DOI: 10.1002/jbm.b.34526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 10/11/2019] [Accepted: 11/09/2019] [Indexed: 11/12/2022]
Abstract
This study deals with the effects of interfacial crack and implant material on mixed-mode stress intensity factor and prediction of interface failure of the cemented acetabular cup. A three dimensional (3D) finite element (FE) model of implanted pelvic bone was developed based on the computed tomography (CT) scan data. Combinations of four materials were considered for implant material. To understand the influence of interfacial crack at bone-cement and cement-implant interfaces on failure, 2D cracked models were developed based on the FE model and solved using the element-free Galerkin method (EFGM) by considering a rectangular section in the superior, inferior, anterior, and posterior locations. Interface failure was predicted in terms of mixed-mode stress intensity factor (SIF). The stress values obtained from FE analysis were transferred at the cut boundary of the rectangular section and considered as a mixed-mode loading condition to determine the SIF in the superior, inferior, anterior, and posterior locations at bone-cement and cement-implant interfaces using EFGM. Location wise, anterior seems to have more chances of failure because SIF in the anterior location was found to be higher than other locations. The bone-cement interface has more SIF and indicated more chances of failure than the cement-implant interface. Less SIF was found for the ceramic-ceramic material combination than other material combinations.
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Affiliation(s)
- Ajay Kumar
- School of Engineering, Indian Institute of Technology Mandi, Kamand, Himachal Pradesh, India
| | - Rajesh Ghosh
- School of Engineering, Indian Institute of Technology Mandi, Kamand, Himachal Pradesh, India
| | - Rajeev Kumar
- School of Engineering, Indian Institute of Technology Mandi, Kamand, Himachal Pradesh, India
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17
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Partridge S, Buckley P, de Boer G, Williams S. A novel method to measure rim deformation in UHMWPE acetabular liners. Med Eng Phys 2018; 59:56-62. [PMID: 30057256 DOI: 10.1016/j.medengphy.2018.04.023] [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: 01/03/2018] [Revised: 03/27/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
Fluoroscopy studies of total hip replacement (THR) have shown that the femoral head and acetabular cup can separate in vivo, causing edge loading on the rim of the cup. Pre-clinical testing of THR involves ISO standard motion and loading parameters that are representative of a standard walking gait. However, a requirement for more robust testing of THR has been identified and protocols for edge loading in hip simulators have been developed. This technical note describes a method to measure rim wear and deformation on ultra-high molecular weight polyethylene acetabular liners using 2D contacting profilometry and Matlab® analysis. The method is demonstrated on liners that have been subjected to edge loading in hip simulator tests and that have been retrieved at revision surgery. A quantitative and qualitative evaluation of the rim deformation was performed with good repeatability using the method.
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Affiliation(s)
- Susan Partridge
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK.
| | - Paige Buckley
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
| | - Greg de Boer
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
| | - Sophie Williams
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
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18
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Effects of Material Thickness and Surface Modification of Cross-linked Polyethylene with Poly(2-Methacryloyloxyethyl Phosphorylcholine) on Its Deformation Behavior, Wear Resistance, and Durability Under Repetitive Impact-to-sliding Motion. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.biotri.2017.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Takada R, Jinno T, Koga D, Miyatake K, Muneta T, Okawa A. Comparison of wear rate and osteolysis between second-generation annealed and first-generation remelted highly cross-linked polyethylene in total hip arthroplasty. A case control study at a minimum of five years. Orthop Traumatol Surg Res 2017; 103:537-541. [PMID: 28300705 DOI: 10.1016/j.otsr.2017.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/15/2017] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no previous report that directly compared wear resistance of second-generation annealed highly cross-linked polyethylene with that of first-generation remelted highly cross-linked polyethylene. We therefore performed a retrospective study at a minimum of 5-year follow-up comparing second-generation annealed and first-generation remelted highly cross-linked polyethylene in order to: (1) assess wear rates and (2) compare the incidence of osteolysis between, (3) identify the frequency of complication related to the two types of highly cross-linked polyethylene. HYPOTHESIS There is a difference in the linear wear rate and the incidence of osteolysis between the two types of highly cross-linked polyethylene in total hip arthroplasty. MATERIALS AND METHODS In a single centre study, we reviewed 123 primary cementless total hip arthroplasties between 2010 and 2011 that were performed with 32mm alumina ceramic on second-generation annealed (X3) or first-generation remelted (Longevity) highly cross-linked polyethylene liner. There was no specific reason for the choice of the type of highly cross-linked polyethylene. There were no significant differences between the two groups in respect of gender, diagnosis, body mass index, pre- and post-operative functional and activity score, cup size, and cup orientation except the younger age in the X3 group. The mean wear rate and the incidence of osteolysis were evaluated at the latest follow-up. RESULTS One hundred nine cases followed over 5 years post-operatively (88.6% in all consecutive cases) were evaluated. X3 and Longevity were used in 54 and 55 cases, respectively. The mean follow-up was 5.3 years in both groups. The mean linear wear rate of X3 and Longevity group was 0.045±0.023mm/year and 0.076±0.031mm/year, respectively (P<0.001). No osteolysis was found on plain X-rays in both groups and no specific complication was related to these highly cross-linked components. DISCUSSION Excellent wear resistance of both types of highly cross-linked polyethylene liner was revealed in our study. The difference of wear rate between two materials should be monitored in a longer follow-up. LEVEL OF EVIDENCE Level III retrospective case control study.
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Affiliation(s)
- R Takada
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - T Jinno
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - D Koga
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - K Miyatake
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - T Muneta
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - A Okawa
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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20
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Yamamoto K, Tateiwa T, Takahashi Y. Vitamin E-stabilized highly crosslinked polyethylenes: The role and effectiveness in total hip arthroplasty. J Orthop Sci 2017; 22:384-390. [PMID: 28209339 DOI: 10.1016/j.jos.2017.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/15/2016] [Accepted: 01/19/2017] [Indexed: 02/09/2023]
Abstract
Morphology and design of ultra-high molecular weight polyethylene (UHMWPE or simply PE) acetabular components used in total hip arthroplasty (THA) have been evolving for more than half a century. Since the late-1990s, there were two major technological innovations in PE emerged from necessity to overcome the wear-induced periprosthetic osteolysis, i.e., the development of highly crosslinked PEs (HXLPEs). There are many literature reporting that radiation crosslinked and remelted/annealed (first-generation) HXLPEs markedly reduced the incidence of osteolysis and aseptic loosening. Regardless of such clinical success in the first-generation technologies, there were some recent shifts in Japan toward the use of new second-generation HXLPEs subjected to sequential irradiation/annealing or antioxidant vitamin E (α-tocopherol) incorporation. Although the selection rate of first-generation liners still account for more than half of all the PE THAs (∼58% in 2015), the use of vitamin E-stabilized liners has been steadily growing each year since their clinical introduction in 2010. In these contexts, it is of great importance to evaluate and understand the real clinical benefits of using the new second-generation liners as compared to the first generation. This article first summarizes structural evolution and characteristic features of first-generation HXLPEs, and then provides a detailed description of second-generation antioxidant HXLPEs in regard to the role of vitamin E incorporation on their chemical and mechanical performances in THA.
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Affiliation(s)
- Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Toshiyuki Tateiwa
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yasuhito Takahashi
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; Department of Bone and Joint Biomaterial Research, Tokyo Medical University, 6-7-1,Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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21
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Tsukamoto M, Ohnishi H, Mori T, Kawasaki M, Uchida S, Sakai A. Fifteen-Year Comparison of Wear and Osteolysis Analysis for Cross-Linked or Conventional Polyethylene in Cementless Total Hip Arthroplasty for Hip Dysplasia-A Retrospective Cohort Study. J Arthroplasty 2017; 32:161-165.e1. [PMID: 27444850 DOI: 10.1016/j.arth.2016.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/05/2016] [Accepted: 06/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cross-linked polyethylene (XLPE) acetabular liners used in cementless total hip arthroplasty (THA) have demonstrated better wear resistance at 10 years compared with conventional polyethylene (CPE) liners. No clinical studies have compared XPLE to CPE liners beyond 10 years. METHODS We performed a 15-year retrospective cohort study on cementless THA performed in patients with developmental hip dysplasia to measure the differences in polyethylene wear rates and the presence of osteolysis. Twenty-four THAs with XLPE and 17 THAs with CPE were evaluated. The mean age of patients was 55.9 years (41-68) in the XLPE group and 54.4 years (40-67) in the CPE group. The mean follow-up period was 15.1 years (13.9-16.1) in the XLPE group and 15.2 years (14.5-16.0) in the CPE group. RESULTS The XLPE group had a significantly lower wear rate at 5 and 10 years compared with the CPE group; however, no significant difference was found at 15 years (XLPE group, 0.040 mm/y; CPE group, 0.034 mm/y). In addition, the incidence of osteolysis did not differ significantly between the groups. However, the incidence of excessive wear between 10 and 15 years after surgery in the XLPE group was significantly higher than that in the CPE group. CONCLUSION XLPE demonstrated no advantage in the wear rate or the incidence of osteolysis at 15 years, despite having superior wear resistance up to 10 years. It is concerning that the incidence of excessive wear was higher in the XLPE group between 10 and 15 years, and this finding should alert the arthroplasty community to this possible problem with the more highly cross-linked polyethylene.
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Affiliation(s)
- Manabu Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hideo Ohnishi
- Department of Orthopaedic Surgery, Moji Medical Center, Kitakyushu, Japan
| | - Toshiharu Mori
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Makoto Kawasaki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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22
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Early catastrophic failure of a PINNACLE MARATHON® polyethylene acetabular liner: a report of a malpositioned PINNACLE DUOFIX HA® acetabular shell resulting in point loading and accelerated wear. Hip Int 2016; 26:e52-e55. [PMID: 27739572 DOI: 10.5301/hipint.5000447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Highly cross-linked polyethylene in total hip arthroplasty (THA) has been shown to decrease wear rate compared with a conventional polyethylene liner. However, it has also been reported that the manufacturing processes can cause early failure of the implant. CASE We describe early catastrophic failure at <4 years following primary THA surgery of a PINNACLE MARATHON® polyethylene acetabular liner resulting from a malaligned PINNACLE DUOFIX HA® acetabular shell with resultant point loading. Radiographs revealed a malaligned acetabular shell and superior subluxation of the femoral head out of the liner. At revision surgery operative findings revealed that the acetabular shell alignment was in of 50° of anteversion and 70° of inclination. Significant metallosis in the surrounding tissues was observed. CONCLUSIONS We conclude that a malpositioned acetabular shell resulting in point loading and abnormal contact stresses was the mechanism of failure. Our case highlights the importance of achieving correct acetabular component alignment in total hip arthroplasty.
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23
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Comparison of wear rate and osteolysis between annealed and remelted highly cross-linked polyethylene in total hip arthroplasty. A case control study at 7 to 10 years follow-up. Orthop Traumatol Surg Res 2016; 102:717-21. [PMID: 27291079 DOI: 10.1016/j.otsr.2016.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/22/2016] [Accepted: 04/27/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Low polyethylene wear rate and low incidence of osteolysis after total hip arthroplasty using annealed and remelted highly cross-linked polyethylene have been reported. However, there is no previous report that directly compared both types of highly cross-linked polyethylene. We therefore performed a retrospective study on a series of highly cross-linked polyethylene, in order to: (1) compare wear rates and the incidence of osteolysis between annealed and remelted highly cross-linked polyethylene at 7-10 years; (2) identify the frequency of complication related to annealed and remelted highly cross-linked polyethylene. HYPOTHESIS There is no difference in the linear wear rate and the incidence of osteolysis between the annealed and remelted highly cross-linked polyethylene in total hip arthroplasty. PATIENTS AND METHODS Two hundred and sixteen cases of cementless total hip arthroplasties with annealed or remelted highly cross-linked polyethylene, which were performed between January 2003 and December 2006 in one institution, were followed for 7-10 years and received computed tomography scan, in addition to radiography at the latest follow-up. Annealed and remelted highly cross-linked polyethylene was used in 91 cases and 125 cases, respectively. A 26-mm cobalt-chromium head was used in all cases. Penetration rates from 1 year to the last evaluation were used to estimate the yearly linear wear rate. Existence of osteolysis was evaluated by plain radiography and computed tomography. RESULTS There were no significant differences in patients' background between the two groups. The linear wear rate of annealed and remelted group was 0.031±0.022mm/year and 0.032±0.020mm/year, respectively (P=0.91). Two cases of small femoral osteolysis were found in the annealed group. Any complication related to highly cross-linked polyethylene was not found in both groups. DISCUSSION There was no significant difference in the linear wear rate and the incidence of osteolysis between the annealed and remelted group at postoperative 7 to 10 years. Excellent results of both types of highly cross-linked polyethylene were revealed by this study. LEVEL OF EVIDENCE Level III retrospective case control study.
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Choi WK, Cho MR, Chae SB, Kim DY. A Liner Breakage in Total Hip Arthroplasty after Using 1st Generation Highly Cross Linked Polyethylene Mated against 36-mm Metal Head: A Case Report. Hip Pelvis 2016; 27:192-5. [PMID: 27536625 PMCID: PMC4972726 DOI: 10.5371/hp.2015.27.3.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/03/2015] [Accepted: 08/25/2015] [Indexed: 11/24/2022] Open
Abstract
It has been known the highly cross linked polyethylene (HXLPE) has an advantage of improved wear rate. However, the alteration in mechanical properties such as decreased tensile yield and fatigue strength make concerns about fragility of HXLPE. We experienced a case of HXLPE breakage. But, this case of liner breakage happened although patient belonged to normal BMI and proper acetabular cup position so called "safe zone" on radiographs. So, we report this case with reference review.
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Affiliation(s)
- Won-Kee Choi
- Department of Orthopaedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Myung-Rae Cho
- Department of Orthopaedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Seung-Bum Chae
- Department of Orthopaedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
| | - Dong-Young Kim
- Department of Orthopaedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
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25
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Ansari F, Gludovatz B, Kozak A, Ritchie RO, Pruitt LA. Notch fatigue of ultrahigh molecular weight polyethylene (UHMWPE) used in total joint replacements. J Mech Behav Biomed Mater 2016; 60:267-279. [DOI: 10.1016/j.jmbbm.2016.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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26
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Homma Y, Baba T, Kobayashi H, Desroches A, Ochi H, Ozaki Y, Matsumoto M, Yuasa T, Kaneko K. Benefit and risk in short term after total hip arthroplasty by direct anterior approach combined with dual mobility cup. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:619-24. [PMID: 27311447 DOI: 10.1007/s00590-016-1808-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/12/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE No previous reports have described the benefits and risks associated with the dual mobility cup (DMC) in primary THA via direct anterior approach (DAA). The aim of this study was to compare the safety and rate of early postoperative complication of the DAA with the DMC for THA with those of the DAA with a single standard cup, and to investigate the influence of the learning curve of the use of DMC on intra- and perioperative outcomes. METHODS We retrospectively investigated 60 hips treated in the single-DAA group and 60 hips treated in the dual-DAA group. A primary/secondary outcome variable was the presence of any intra- or perioperative complication within the first 6 months/the operative time and hip function at 6 months postoperatively. We also analyzed influence of the learning curve of the use of DMC on intra- and perioperative outcomes. RESULTS No intraoperative complications were observed in either group. One anterior dislocation and one periprosthetic hip fracture were occurred in the single-DAA group. The surgical times in the single-DAA and dual-DAA groups were 112.0 ± 20.9 and 121.0 ± 26.9 min (p < 0.001). There was no significant difference in the 6-month postoperative hip function scores between the two groups. There was no influence of the learning curve of the use of DMC on intra- and perioperative outcomes. CONCLUSION We have demonstrated the short-term safety and lack of inferiority of using the DMC in the DAA compared with the standard single mobility cup.
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Affiliation(s)
- Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Asuka Desroches
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Hôpital Henri Mondor, Créteil, France
| | - Hironori Ochi
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yu Ozaki
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Mikio Matsumoto
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takahito Yuasa
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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D'Antonio J, Capello WN, Ramakrishnan R. Once Annealed Highly Cross-Linked Polyethylene Exhibits Low Wear at 9 to 15 Years. Orthopedics 2016; 39:e565-71. [PMID: 27088350 DOI: 10.3928/01477447-20160414-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/17/2015] [Indexed: 02/03/2023]
Abstract
A once annealed highly cross-linked polyethylene (HXLPE) was introduced in 1998. Concerns regarding its long-term performance and oxidative resistance exist because of the presence of retained free radicals. The authors studied 48 patients with 50 hip implants having an average age of 62 years. They were followed for 9 to 15 years. The purpose of this study was to determine linear wear rate and the incidence of osteolysis and/or mechanical failure. At an average follow-up of 12.2 years, the annual linear wear rate was 0.018 mm (SD, 0.024 mm). No mechanical failures or osteolysis have been found to date. The clinical performance of this HXLPE continues to meet expectations despite the presence of free radicals. [Orthopedics. 2016; 39(3):e565-e571.].
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Dibra F, Parvataneni H. An unusual presentation of catastrophic failure of hip arthroplasty with a thigh mass. Arthroplast Today 2016; 2:63-67. [PMID: 28326401 PMCID: PMC4957158 DOI: 10.1016/j.artd.2016.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/12/2016] [Accepted: 03/17/2016] [Indexed: 12/05/2022] Open
Abstract
In the advent of increasing demand for total hip arthroplasty, surveillance of these patients is imperative to identify potential complications requiring revision surgery. This is especially important in the young population, as revision is usually necessary during their lifetime. We present a case of a young female patient with a history of total hip arthroplasty 17 years prior, who presented with left hip pain and anterior thigh mass. The prosthetic hip had progressed to catastrophic failure with the cobalt-chrome femoral head having eroded through the polyethylene and acetabular socket. This was associated with significant metal debris and large fluid collection in the thigh. The patient required complex revision surgery but could have had a much lesser procedure with earlier intervention.
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Affiliation(s)
- Florian Dibra
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
- Corresponding author. 3450 Hull Road, Gainesville, FL 32607, USA. Tel.: +1 610 420 554.3450 Hull RoadGainesvilleFL32607USA
| | - Hari Parvataneni
- Division of Arthroplasty, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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Yee MA, O'Keefe TJ, Winter S. Incarcerated fracture fragments of Longevity polyethylene liners after total hip arthroplasty. Arthroplast Today 2016; 2:6-10. [PMID: 28326389 PMCID: PMC4957170 DOI: 10.1016/j.artd.2015.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/25/2022] Open
Abstract
Highly cross-linked polyethylene liners are widely used in total hip arthroplasty because they experience lower wear rates than conventional polyethylene liners. However, the cross-linking process does decrease the resistance of polyethylene to fatigue failure and fracture. This report describes 2 cases of highly cross-linked polyethylene liner fracture occurring in association with hip dislocation and unsuccessful closed reduction consequent to blockage by an incarcerated liner fragment. These cases highlight the known polyethylene fracture risk factors of thin and unsupported polyethylene and large bearing sizes. They also reinforce the importance of a careful evaluation of postreduction radiographs for the presence of a concentric reduction and provide a possible explanation for postoperative hip instability, multiple dislocations, and incomplete seating of the femoral head on attempts at closed reduction.
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Affiliation(s)
- Michael A Yee
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas J O'Keefe
- Department of Orthopaedic Surgery, St. Joseph Mercy Health System, Ann Arbor, MI, USA
| | - Suzanne Winter
- Department of Orthopaedic Surgery, St. Joseph Mercy Health System, Ann Arbor, MI, USA
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Abstract
Dislocation remains among the most common complications of, and reasons for, revision of both primary and revision total hip replacements (THR). Hence, there is great interest in maximising stability to prevent this complication. Head size has been recognised to have a strong influence on the risk of dislocation post-operatively. As femoral head size increases, stability is augmented, secondary to an increase in impingement-free range of movement. Larger head sizes also greatly increase the 'jump distance' required for the head to dislocate in an appropriately positioned cup. Level-one studies support the use of larger diameter heads as they decrease the risk of dislocation following primary and revision THR. Highly cross-linked polyethylene has allowed us to increase femoral head size, without a marked increase in wear. However, the thin polyethylene liners necessary to accommodate larger heads may increase the risk of liner fracture and larger heads have also been implicated in causing soft-tissue impingement resulting in groin pain. Larger diameter heads also impart larger forces on the femoral trunnion, which may contribute to corrosion, metal release, and adverse local tissue reactions. Alternative large bearings including large ceramic heads and dual mobility bearings may mitigate some of these risks, and several of these devices have been used with clinical success.
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Affiliation(s)
- H J Cooper
- Lenox Hill Hospital, Department of Orthopaedic Surgery, 130 East 77th Street, New York, 10075, USA
| | - C J Della Valle
- Rush University Medical Center, Department of Orthopaedic Surgery, 1611 West Harrison Street, Chicago, Illinois, 60612, USA
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Standing versus supine radiographs to evaluate femoral head penetration in the polyethylene liner after total hip arthroplasty. J Arthroplasty 2014; 29:2415-9. [PMID: 24742717 DOI: 10.1016/j.arth.2014.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/29/2014] [Accepted: 02/05/2014] [Indexed: 02/01/2023] Open
Abstract
The linear penetration rates for ceramic femoral heads on conventional and highly cross-linked polyethylene were measured and compared with radiographs taken in the standing and supine position taken three weeks postoperatively and at final follow-up. Seventy-five patients (83 hips) with conventional polyethylene (group-1) and two hundred and seventy five patients (300 hips) with highly cross-linked polyethylene (group-2) were studied. Follow-up periods were 14.5years in group-1 and 8.6years in group-2. The average penetration rates in group-1 were 0.17mm/year in supine position and 0.18mm/year in standing position (P<0.05). On the other hand, the rates in group-2 were 0.03mm/year and 0.04mm/year respectively (P<0.05). Although there were statistical differences between groups, 0.01mm differences are probably not clinically relevant.
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32
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Beecher B, Huddleston J, Rowell S, Goodman S, Malchau H, Kwon YM, Muratoglu OK. Material Properties of a Highly Anteverted Vitamin E-Stabilized Polyethylene Liner After Sixteen Months In Vivo: A Case Report. JBJS Case Connect 2014; 4:e57. [PMID: 29252526 DOI: 10.2106/jbjs.cc.m.00134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Benjamin Beecher
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, GJR 1206, Boston, MA 02114.
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Ast MP, John TK, Labbisiere A, Robador N, Valle AGD. Fractures of a single design of highly cross-linked polyethylene acetabular liners: an analysis of voluntary reports to the United States Food and Drug Administration. J Arthroplasty 2014; 29:1231-5. [PMID: 24444569 DOI: 10.1016/j.arth.2013.12.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/03/2013] [Accepted: 12/13/2013] [Indexed: 02/01/2023] Open
Abstract
Polyethylene liner fracture is a risk associated with the use of highly cross-linked UHMWPE. We performed a review of the voluntary reports of fractured liners to the US Food and Drug Administration to determine if any risk factors could be identified. There have been 74 reports of fractured Trilogy, Longevity liners to the US Food and Drug Administration since 1999. Most cases utilized small acetabular shells (≤54 mm) combined with large diameter heads (≥36 mm). Liners less than 7 mm thick at the weight bearing or 4.8 mm thick at the rim should be used with caution. At revision surgery, malpositioned shells should be revised and the use of a thin liner should be avoided.
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Affiliation(s)
- Michael P Ast
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
| | - Thomas K John
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
| | - Anthony Labbisiere
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
| | - Nicolas Robador
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
| | - Alejandro Gonzalez Della Valle
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement Surgery, Hospital for Special Surgery, New York, New York
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34
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Pezzotti G, Yamamoto K. Artificial hip joints: The biomaterials challenge. J Mech Behav Biomed Mater 2014; 31:3-20. [DOI: 10.1016/j.jmbbm.2013.06.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 05/29/2013] [Accepted: 06/06/2013] [Indexed: 12/21/2022]
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Abstract
Large ceramic femoral heads offer several advantages that are potentially advantageous to patients undergoing both primary and revision total hip replacement. Many high-quality studies have demonstrated the benefit of large femoral heads in reducing post-operative instability. Ceramic femoral heads may also offer an advantage in reducing polyethylene wear that has been reported in vitro and is starting to become clinically apparent in mid-term clinical outcome studies. Additionally, the risk of taper corrosion at a ceramic femoral head-neck junction is clearly lower than when using a metal femoral head. With improvements in the material properties of both modern ceramic femoral heads and polyethylene acetabular liners that have reduced the risk of mechanical complications, large ceramic heads have gained popularity in recent years.
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Affiliation(s)
- J A Rodriguez
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, New York 10075, USA
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36
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Solarino G, Abate A, Morizio A, Vicenti G, Moretti B. Should we use ceramic-on-ceramic coupling with large head in total hip arthroplasty done for displaced femoral neck fracture? ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.sart.2014.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lam L, Drew T, Boscainos P. Effect of acetabular orientation on stress distribution of highly cross-linked polyethylene liners. Orthopedics 2013; 36:e1346-52. [PMID: 24200436 DOI: 10.3928/01477447-20131021-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Several case reports have documented the fracture of highly cross-linked polyethylene (HCLPE) liners used in total hip arthroplasty (THA). Although uncommon, fractured liners result in considerable morbidity for patients and require revision surgery. One postulated mechanism that leads to this type of implant failure is malorientation of the acetabular component. The purpose of this study was to investigate the effect of acetabular orientation on the stress distribution of HCLPE liners used in THA by means of finite element analysis. Three-dimensional models of a commonly used HCLPE liner were created corresponding to 12 different acetabular component orientations (inclination ranging from 20° to 70° and version ranging from 20° of retroversion to 40° of anteversion). A static stress analysis of the finite element models was performed under conditions simulating peak gait loads. The results of the analysis revealed that excessive inclination and extremes of version were associated with an increase in peak stress magnitudes. The locations of peak stress also were found to lie within the rim notch and locking ring groove regions, which were consistent with the fracture locations reported in published case reports. Therefore, the acetabular component should be oriented carefully during implantation to reduce the risk of rim loading and subsequent liner fracture. In addition, an alternative liner design may further help reduce stress risers and risk of fracture.
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38
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Zietz C, Fabry C, Middelborg L, Fulda G, Mittelmeier W, Bader R. Wear testing and particle characterisation of sequentially crosslinked polyethylene acetabular liners using different femoral head sizes. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:2057-2065. [PMID: 23615788 DOI: 10.1007/s10856-013-4936-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 04/19/2013] [Indexed: 06/02/2023]
Abstract
Larger femoral heads lead to a decreased risk of total hip dislocation and an improved range of motion. However, the larger diameter is associated with increased wear rates. The low wear rates of crosslinked polyethylene opens up the possibility of using larger heads. The aim of this experimental study was to evaluate the wear of conventional non-crosslinked versus sequentially crosslinked polyethylene liners in combination with different ceramic head sizes (28, 36, 44 mm). Wear testing was performed in a hip simulator according to ISO 14242. Wear particles from the polyethylene liners were characterized after wear testing. The wear measurements revealed a significant increase in the wear of crosslinked polyethylene liners with larger heads. By sequential crosslinking, however, the gravimetric wear using larger heads was reduced to a fractional amount of the wear using conventional polyethylene. Significant differences were observed for particle morphology but not for the number of particles when comparing non-crosslinked and crosslinked polyethylene.
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Affiliation(s)
- Carmen Zietz
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057, Rostock, Germany.
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39
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Pruitt LA, Ansari F, Kury M, Mehdizah A, Patten EW, Huddlestein J, Mickelson D, Chang J, Hubert K, Ries MD. Clinical trade-offs in cross-linked ultrahigh-molecular-weight polyethylene used in total joint arthroplasty. J Biomed Mater Res B Appl Biomater 2013; 101:476-84. [PMID: 23436567 DOI: 10.1002/jbm.b.32887] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 08/15/2012] [Accepted: 11/18/2012] [Indexed: 11/09/2022]
Abstract
Highly cross-linked formulations of ultrahigh-molecular-weight polyethylene (XLPE) offer exceptional wear resistance for total joint arthroplasty but are offset with a reduction in postyield and fatigue fracture properties in comparison to conventional ultrahigh-molecular-weight polyethylene (UHMWPE). Oxidation resistance is also an important property for the longevity of total joint replacements (TJRs) as formulations of UHMWPE or XLPE utilizing radiation methods are susceptible to free radical generation and subsequent embrittlement. The balance of oxidation, wear, and fracture properties is an enduring concern for orthopedic polymers used as the bearing surface in total joint arthroplasty. Optimization of material properties is further challenged in designs that make use of locking mechanisms, notches, or other stress concentrations that can render the polymer susceptible to fracture due to elevated local stresses. Clinical complications involving impingements, dislocations, or other biomechanical overloads can exacerbate stresses and negate benefits of improved wear resistance provided by XLPE. This work examines trade-offs that factor into the use of XLPE in TJR implants.
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Affiliation(s)
- Lisa A Pruitt
- Department of Mechanical Engineering, University of California, Berkeley, California, USA
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40
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Paterson NR, Teeter MG, Macdonald SJ, McCalden RW, Howard JL, Naudie DDR. Highly cross-linked vs conventional polyethylene: no differences in rim notching from micromotion on retrieved acetabular liners. J Arthroplasty 2012; 27:1616-1621.e1. [PMID: 22608684 DOI: 10.1016/j.arth.2012.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 03/18/2012] [Indexed: 02/01/2023] Open
Abstract
Previous literature suggested highly cross-linked acetabular liners demonstrated notching patterns that may be a point of crack origin and rim failure. We examined (1) whether notching patterns and rim cracks existed and demonstrated similar morphological properties in retrieved highly cross-linked and non-cross-linked liners and (2) whether the dimensions of these notches correlated with their duration of implantation. We retrieved a series of 14 identical liners out to an average of 2.03 years. Liners were microscopically examined and then scanned using microcomputed tomography. All liners demonstrated identical notching patterns. Microcomputed tomographic scans demonstrated no signs of crack initiation or rim failure but were able to accurately quantify the notch dimensions. The notching patterns were likely caused by liner-cup micromotion and are better characterized as creep deformation because they did not progress markedly over longer durations of implantation.
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Affiliation(s)
- Nicholas R Paterson
- Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ontario, Canada
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41
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Goldstein MJ, Ast MP, Dimaio FR. Acute posttraumatic catastrophic failure of a second-generation, highly cross-linked ultra-high-molecular-weight polyethylene patellar component. Orthopedics 2012; 35:e1119-21. [PMID: 22784913 DOI: 10.3928/01477447-20120621-35] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 74-year-old man underwent total knee arthroplasty in 1996 and subsequent revision total knee arthroplasty for aseptic loosening in 2005. During revision, an all-polyethylene, 7-mm, second-generation, highly cross-linked ultra-high-molecular-weight polyethylene patellar component (Durasul; Zimmer, Warsaw, Indiana) was used. The patient recovered well, but he presented with severe acute pain after a popping feeling was detected during a game of golf in postoperative year 4. Radiographs demonstrated a fracture of the patellar component. At re-revision surgery, polyethylene fragments were encountered without visual evidence of wear. Appropriate rotational and axial alignment of the components was confirmed. Patellar revision was performed. To the authors' knowledge, this is the first report of an acute posttraumatic catastrophic fracture of a second-generation, highly cross-linked ultra-high-molecular-weight polyethylene patellar component. Although no malposition of the components was noted, abnormal tensile forces across the patellar component can be transmitted by altered patellofemoral kinematics. This combination could lead to a small surface crack that propagates deeper into the component with continued impaction and an eventual acute fracture of the entire component. The patellar component failed in a piecemeal fashion following acute trauma. Although many advantages exist to the enhancement of polyethylene patellar components, including the potential for improved wear characteristics, cross-linking has reduced resistance to crack initiation and propagation. Therefore, fracture risk should be considered when using second-generation, highly cross-linked ultra-high-molecular-weight polyethylene.
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Affiliation(s)
- Matthew J Goldstein
- Department of Orthopaedic Surgery, North Shore-Long Island Jewish Health System, 270-05 76th Ave, Room 250, New Hyde Park, NY 11040, USA
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42
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Kurtz SM, Gawel HA, Patel JD. History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Relat Res 2011; 469:2262-77. [PMID: 21431461 PMCID: PMC3126942 DOI: 10.1007/s11999-011-1872-4] [Citation(s) in RCA: 313] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and osteolysis in total joint arthroplasty. While many studies report wear and osteolysis associated with HXLPE, analytical techniques, clinical study design and followup, HXLPE formulation and implant design characteristics, and patient populations differ substantially among investigations, complicating a unified perspective. QUESTIONS/PURPOSES Literature on first-generation HXLPE was summarized. We systematically reviewed the radiographic wear data and incidence of osteolysis for HXLPE in hip and knee arthroplasty. METHODS PubMed identified 391 studies; 28 met inclusion criteria for a weighted-averages analysis of two-dimensional femoral head penetration rates. To determine the incidence of osteolysis, we estimated a pooled odds ratio using a random-effects model. RESULTS Weighted-averages analyses of femoral head penetration rates in HXLPE liners and conventional UHMWPE liners resulted, respectively, in a mean two-dimensional linear penetration rate of 0.042 mm/year based on 28 studies (n=1503 hips) and 0.137 mm/year based on 18 studies (n=695 hips). The pooled odds ratio for the risk of osteolysis in HXLPE versus conventional liners was 0.13 (95% confidence interval, 0.06-0.27) among studies with minimum 5-year followup. We identified two clinical studies of HXLPE in TKA, preventing systematic analysis of outcomes. CONCLUSIONS HXLPE liner studies consistently report lower femoral head penetration and an 87% lower risk of osteolysis. Reduction in femoral head penetration or osteolysis risk is not established for large-diameter (>32 mm) metallic femoral heads or ceramic femoral heads of any size. Few studies document the clinical performance of HXLPE in knees.
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Affiliation(s)
- Steven M Kurtz
- Exponent, Inc, 3401 Market Street, Suite 300, Philadelphia, PA 19104, USA.
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43
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Blumenfeld TJ, McKellop HA, Schmalzried TP, Billi F. Fracture of a cross-linked polyethylene liner: a multifactorial issue. J Arthroplasty 2011; 26:666.e5-8. [PMID: 20851563 DOI: 10.1016/j.arth.2010.07.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 07/15/2010] [Indexed: 02/01/2023] Open
Abstract
A limited number of reports have detailed the cause of fracture of a highly cross-linked polyethylene liner. Typically, the fractures have occurred in a region of thin and/or unsupported polyethylene, in association with superiorly directed edge loading conditions secondary to an excessively inclinated acetabular component. This case report details an unusual fracture mechanism of a 5-mrad cross-linked liner caused by horizontal loading conditions. The report details several factors that were felt to be etiologic including the specific liner locking mechanism. The treatment options are discussed.
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Affiliation(s)
- Thomas J Blumenfeld
- Sutter Medical Center, University of California at Davis, Sacramento, California 95816, USA
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44
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McGrory CP, McGrory BJ. Anterior subluxation after total hip replacement confirmed by radiographs: report of two cases. Adv Orthop 2011; 2011:519254. [PMID: 21991416 PMCID: PMC3170801 DOI: 10.4061/2011/519254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 03/15/2011] [Indexed: 11/20/2022] Open
Abstract
Demonstrable anterior subluxation of the femoral head after a total hip arthroplasty is a rare complication and is usually transient. Both a case of recurrent subluxation and a case of chronic subluxation are described in this paper, each one presenting with unexpected femoral head eccentricity in the acetabulum on radiograph. We show how this unusual complication can be successfully identified and treated.
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Affiliation(s)
| | - Brian J. McGrory
- Maine Joint Replacement Institute, Portland, ME 04102, USA
- Orthopaedic Associates, 33 Sewall Street, Portland, ME 04104, USA
- Joint Replacement Center, Maine Medical Center, Portland, ME 04102, USA
- Division of Orthopaedics and Rehabilitation, College of Medicine, The University of Vermont, Burlington, VT 05405, USA
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45
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Thomas GER, Simpson DJ, Mehmood S, Taylor A, McLardy-Smith P, Gill HS, Murray DW, Glyn-Jones S. The seven-year wear of highly cross-linked polyethylene in total hip arthroplasty: a double-blind, randomized controlled trial using radiostereometric analysis. J Bone Joint Surg Am 2011; 93:716-22. [PMID: 21508278 DOI: 10.2106/jbjs.j.00287] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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 prospective, 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 [CI], ±0.10 mm) than it was in the ultra-high molecular weight polyethylene group (0.55 mm; 95% CI, ±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% CI, ±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.
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Abstract
BACKGROUND The low wear rates of crosslinked polyethylenes provide the potential to use larger diameters to resist dislocation. However, this requires the use of thinner liners in the acetabular component, with concern that higher contact stresses will increase wear, offsetting the benefits of the crosslinking. QUESTIONS/PURPOSES We asked the following questions: Is the wear of conventional and crosslinked polyethylene liners affected by ball diameter, rigidity of backing, and liner thickness? Are the stresses in the liner affected by thickness? METHODS Wear rates were measured in a hip simulator and stresses were calculated using finite element modeling. RESULTS Without crosslinking, the wear rate was 4% to 10% greater with a 36-mm diameter than a 28-mm diameter. With crosslinking, wear was 9% lower with a 36-mm diameter without metal backing and 4% greater with metal backing. Reducing the thickness from 6 mm to 3 mm increased the contact stress by 46%, but the wear rate decreased by 19%. CONCLUSIONS The reduction in wear with 5 Mrad of crosslinking was not offset by increasing the diameter from 28 mm to 36 mm or by using a liner as thin as 3 mm. CLINICAL RELEVANCE The results indicate, for a properly positioned 5-Mrad crosslinked acetabular component and within the range of dimensions evaluated, neither wear nor stresses in the polyethylene are limiting factors in the use of larger-diameter, thinner cups to resist dislocation.
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Affiliation(s)
- Fu-Wen Shen
- The J. Vernon Luck Sr., MD, Orthopaedic Research Center, UCLA & Orthopaedic Hospital Department of Orthopaedic Surgery, 2400 S Flower Street, Los Angeles, CA 90007 USA
| | - Zhen Lu
- The J. Vernon Luck Sr., MD, Orthopaedic Research Center, UCLA & Orthopaedic Hospital Department of Orthopaedic Surgery, 2400 S Flower Street, Los Angeles, CA 90007 USA
| | - Harry A. McKellop
- The J. Vernon Luck Sr., MD, Orthopaedic Research Center, UCLA & Orthopaedic Hospital Department of Orthopaedic Surgery, 2400 S Flower Street, Los Angeles, CA 90007 USA
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47
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Kurtz SM, Medel F, MacDonald D, Parvizi J, Kraay M, Rimnac C. Reasons for revision of first-generation highly cross-linked polyethylenes. J Arthroplasty 2010; 25:67-74. [PMID: 20541895 PMCID: PMC2946323 DOI: 10.1016/j.arth.2010.04.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 04/01/2010] [Indexed: 02/01/2023] Open
Abstract
Over a 10-year period, we prospectively evaluated the reasons for revision of contemporary and highly cross-linked polyethylene formulations in amulticenter retrieval program. Two hundred twelve consecutive retrievals were classified as conventional gamma inert sterilized (n = 37), annealed (Cross fire,[Stryker Orthopedics, Mahwah, NJ] n = 72), or remelted (Longevity [Zimmer ,Warsaw, Ind], XLPE[Smith and Nephew, Memphis, Tenn], Durasul [Zimmer,Warsaw, Ind] n = 103) liners. The most frequent reasons for revision were loosening (35%), instability(28%), and infection (21%) and were not related to polyethylene formulation (P = .17). Annealed and remelted liners had comparable linear penetration rates(0.03 and 0.04 mm/y, respectively, on average), and these were significantly lower than the rate in conventional retrievals (0.11 mm/y, P ≤ .0005). This retrieval study including first-generation highly cross linked liners demonstrated lower wear than conventional polyethylene. Although loosening remained as the most prevalent reason for revision, we could not demonstrate a relationship between wear and loosening.The long-term clinical performance of first-generation highly cross-linked liners remains promising based on the midterm outcomes of the components documented in this study [corrected].
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Affiliation(s)
- Steven M. Kurtz
- Implant Research Center, School of Biomedical Engineering, Science, and Heath Systems, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104,Please address correspondence to: Steven M. Kurtz, Ph.D., 3401 Market St., Suite 300, Philadelphia, PA 19104, Phone: (215) 594-8851, Fax: (215) 594-8898,
| | - Francisco Medel
- Implant Research Center, School of Biomedical Engineering, Science, and Heath Systems, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104
| | - Daniel MacDonald
- Implant Research Center, School of Biomedical Engineering, Science, and Heath Systems, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104
| | - Javad Parvizi
- Rothman Institute at Jefferson, 925 Chestnut Street, Philadelphia, PA 19107
| | - Matthew Kraay
- Case Western Reserve University, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106
| | - Clare Rimnac
- Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106
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48
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Yeung E, Thornton-Bott P, Walter WL. Ceramic-on-Ceramic: For the Hard of Hearing and Living Alone—Opposes. ACTA ACUST UNITED AC 2010. [DOI: 10.1053/j.sart.2010.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hamilton WG, McAuley JP, Dennis DA, Murphy JA, Blumenfeld TJ, Politi J. THA with Delta ceramic on ceramic: results of a multicenter investigational device exemption trial. Clin Orthop Relat Res 2010; 468:358-66. [PMID: 19768515 PMCID: PMC2807004 DOI: 10.1007/s11999-009-1091-4] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 08/28/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Although the published studies on the outcomes of total hip arthroplasty (THA) performed with currently available ceramic components show high survivorship and low bearing wear at midterm followup, concern over ceramic fracture and squeaking persist. For these reasons, the use of ceramic is limited. Recently, a new alumina matrix composite material (Delta ceramic) with improved material properties was developed to address these concerns. We report the early outcomes and complications of a prospective, randomized, multicenter trial of 263 patients (264 hips) at eight centers, comparing a Delta ceramic-on-ceramic (COC) articulation with a Delta ceramic head-crosslinked polyethylene bearing combination (COP). There were 177 COC hips and 87 COP hips. Complications were reported for all patients, whereas clinical and radiographic results were provided for the 233 patients with minimum 2-year followup (average, 31.2 months; range, 21-49 months). The Harris hip scores and clinical, radiographic, and survivorship outcomes were similar in both groups. There were four (2%) revisions in the COC group and two (2%) in the COP group. We encountered three intraoperative ceramic liner-related events. In addition, one patient receiving the COC underwent revision for chipping of the ceramic liner, and a second had ceramic fragmentation on followup radiographs but has not undergone revision. These liner related complications remain a concern. No patient reported squeaking in either group; this leaves us hopeful the new material will lessen the frequency of squeaking. In the short term, the Delta COC articulation provided similar functional scores and survivorship and complication rates with the ceramic head mated with crosslinked polyethylene. LEVEL OF EVIDENCE Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- William G Hamilton
- Anderson Orthopaedic Research Institute, 2501 Parkers Lane, Alexandria, VA 22306, USA.
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50
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Gómez-Barrena E, Medel F, Puértolas JA. Polyethylene oxidation in total hip arthroplasty: evolution and new advances. Open Orthop J 2009; 3:115-20. [PMID: 20111694 PMCID: PMC2812841 DOI: 10.2174/1874325000903010115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 10/23/2009] [Accepted: 10/29/2009] [Indexed: 01/06/2023] Open
Abstract
Ultra-high molecular weight polyethylene (UHMWPE) remains the gold standard acetabular bearing material for hip arthroplasty. Its successful performance has shown consistent results and survivorship in total hip replacement (THR) above 85% after 15 years, with different patients, surgeons, or designs. As THR results have been challenged by wear, oxidation, and liner fracture, relevant research on the material properties in the past decade has led to the development and clinical introduction of highly crosslinked polyethylenes (HXLPE). More stress on the bearing (more active, overweighted, younger patients), and more variability in the implantation technique in different small and large Hospitals may further compromise the clinical performance for many patients. The long-term in vivo performance of these materials remains to be proven. Clinical and retrieval studies after more than 5 years of in vivo use with HXLPE in THR are reviewed and consistently show a substantial decrease in wear rate. Moreover, a second generation of improved polyethylenes is backed by in vitro data and awaits more clinical experience to confirm the experimental improvements. Also, new antioxidant, free radical scavengers, candidates and the reinforcement of polyethylene through composites are currently under basic research.Oxidation of polyethylene is today significantly reduced by present formulations, and this forgiving, affordable, and wellknown material is still reliable to meet today's higher requirements in total hip replacement.
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Affiliation(s)
| | - Francisco Medel
- Materials Science and Technology Department-Instituto Ciencia de Materiales de Aragón, Universidad de Zaragoza-CSIC, Spain
| | - José Antonio Puértolas
- Materials Science and Technology Department-I3A, Instituto Ciencia de Materiales de Aragón, Universidad de Zaragoza-CSIC, Spain
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