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. 2023 Mar;31(3):1082-1088.
doi: 10.1007/s00167-022-07226-6. Epub 2022 Nov 21.

Highly cross-linked polyethylene versus conventional polyethylene in primary total knee arthroplasty: comparable clinical and radiological results at a 10-year follow-up

Fortunato Giustra  1 , Alessandro Bistolfi  2 , Francesco Bosco  3 , Nicolò Fresia  1 , Luigi Sabatini  1 , Paola Berchialla  4 , Veronica Sciannameo  4 , Alessandro Massè  1
Affiliations

Highly cross-linked polyethylene versus conventional polyethylene in primary total knee arthroplasty: comparable clinical and radiological results at a 10-year follow-up

Fortunato Giustra et al. Knee Surg Sports Traumatol Arthrosc. 2023 Mar.

Abstract

Purpose: Highly crosslinked polyethylene (HXLPE) was introduced in total knee arthroplasty (TKA) to reduce wear and consequent revisions for loosening due to conventional polyethylene (CPE) wear. This study aims to analyse whether HXLPE is as safe as CPE and could improve the TKA clinical and radiological results in a long-term follow-up.

Methods: This retrospective study included all consecutive starting series of 223 patients with severe primary knee osteoarthritis (OA), with a minimum follow-up of 10 years treated between July 1st, 2007, and July 31st, 2010. After excluding patients who did not respect the inclusion and exclusion criteria, 128 patients were included in the analysis of this study. The patients were then divided into two groups according to the type of polyethylene (PE) implanted: CPE or HXLPE liners. All patients were evaluated for clinical and radiological parameters, causes and revision rates related to the type of PE implanted.

Results: HXLPE appears to be as safe as CPE in TKA, reporting no higher revisions for osteolysis, prosthesis loosening, infection, and mechanical failure. Nevertheless, no statistically significant differences were found between the two groups in the clinical and radiological outcomes evaluated.

Conclusions: Clinical, radiological results, and revision rates are similar between HXLPE and CPE in TKA after 10 years of follow-up, although HXLPE benefits remain controversial.

Level of evidence: III.

Keywords: CPE; Crosslinked; HXLPE; Knee; Polyethylene; Retrospective; Total knee arthroplasty.

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Conflict of interest statement

All authors have no conflicts of interest for this study to disclose.

Figures

Fig. 1
Fig. 1
Consort flow diagram of study: all patients. n number of evaluation cases, CPE conventional polyethylene, HXLPE highly crosslinked polyethylene
Fig. 2
Fig. 2
Multivariate linear regression was performed to examine the KSS knee score post-operative (a) and the KSS function score post-operative (b) in patients treated with HXLPE or CPE. KSS Knee Society Score, CI confidence interval, p p value, CPE conventional polyethylene, HXLPE highly crosslinked polyethylene, M male
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