Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2017 Aug;88(4):363-369.
doi: 10.1080/17453674.2017.1307676. Epub 2017 Apr 4.

Outcome in design-specific comparisons between highly crosslinked and conventional polyethylene in total hip arthroplasty

Per-Erik Johanson  1   2 , Ove Furnes  3   4 , Leif Ivar Havelin  3   4 , Anne Marie Fenstad  3 , Alma B Pedersen  5   6 , Søren Overgaard  7   6 , Göran Garellick  1   2 , Keijo Mäkelä  8   9 , Johan Kärrholm  1   2
Affiliations
Comparative Study

Outcome in design-specific comparisons between highly crosslinked and conventional polyethylene in total hip arthroplasty

Per-Erik Johanson et al. Acta Orthop. 2017 Aug.

Abstract

Background and purpose - Most registry studies regarding highly crosslinked polyethylene (XLPE) have focused on the overall revision risk. We compared the risk of cup and/or liner revision for specific cup and liner designs made of either XLPE or conventional polyethylene (CPE), regarding revision for any reason and revision due to aseptic loosening and/or osteolysis. Patients and methods - Using the Nordic Arthroplasty Register Association (NARA) database, we identified cup and liner designs where either XLPE or CPE had been used in more than 500 THAs performed for primary hip osteoarthritis. We assessed risk of revision for any reason and for aseptic loosening using Cox regression adjusted for age, sex, femoral head material and size, surgical approach, stem fixation, and presence of hydroxyapatite coating (uncemented cups). Results - The CPE version of the ZCA cup had a risk of revision for any reason similar to that of the XLPE version (p = 0.09), but showed a 6-fold higher risk of revision for aseptic loosening (p < 0.001). The CPE version of the Reflection All Poly cup had an 8-fold elevated risk of revision for any reason (p < 0.001) and a 5-fold increased risk of revision for aseptic loosening (p < 0.001). The Charnley Elite Ogee/Marathon cup and the Trilogy cup did not show such differences. Interpretation - Whether XLPE has any advantage over CPE regarding revision risk may depend on the properties of the polyethylene materials being compared, as well as the respective cup designs, fixation type, and follow-up times. Further research is needed to elucidate how cup design factors interact with polyethylene type to affect the risk of revision.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Study group selection sequence
Figure 2.
Figure 2.
Kaplan-Meier cumulative survival curves with 95% confidence intervals for all cemented designs (panel A), ZCA (B), Reflection All Poly (C), and Charnley Elite Ogee/Marathon (D) cups. The follow-up time ended when there were 100 cases at risk in the smallest group (always XLPE). P-values from log-rank test.
Figure 3.
Figure 3.
Kaplan-Meier cumulative survival curves with 95% confidence intervals for all uncemented designs (panel A), and Trilogy cups (B). The follow-up time ended when there were 100 cases at risk in the smallest group (always XLPE). P-values from log-rank test.
See this image and copyright information in PMC

References

    1. Ast M P, John T K, Labbisiere A, Robador N, Valle A G.. 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 (6): 1231–5. - PubMed
    1. Atwood S A, Van Citters D W, Patten E W, Furmanski J, Ries M D, Pruitt L A.. Tradeoffs amongst fatigue, wear, and oxidation resistance of cross-linked ultra-high molecular weight polyethylene. J Mech Behav Biomed Mater 2011; 4 (7): 1033–45. - PubMed
    1. Bragdon C R, Greene M E, Freiberg A A, Harris W H, Malchau H.. Radiostereometric analysis comparison of wear of highly cross-linked polyethylene against 36- vs 28-mm femoral heads. J Arthroplasty 2007; 22 (6 Suppl 2): 125–9. - PubMed
    1. Callary S A, Solomon L B, Holubowycz O T, Campbell D G, Munn Z, Howie D W.. Wear of highly crosslinked polyethylene acetabular components. Acta Orthop 2015; 86 (2): 159–68. - PMC - PubMed
    1. Currier B H, Van Citters D W, Currier J H, Collier J P.. In vivo oxidation in remelted highly cross-linked retrievals. J Bone Joint Surg Am 2010; 92 (14): 2409–18. - PubMed

Publication types

MeSH terms