Elsevier

The Journal of Arthroplasty

Volume 34, Issue 9, September 2019, Pages 2016-2021
The Journal of Arthroplasty

Primary Arthroplasty
Ten- to Sixteen-Year Follow-Up of Highly Cross-Linked Polyethylene in Total Hip Arthroplasty: What Factors Affect Wear?

https://doi.org/10.1016/j.arth.2019.04.041Get rights and content

Abstract

Background

Increase in acetabular cup abduction in total hip arthroplasty (THA) using conventional polyethylene is associated with greater linear wear. Whether this relationship holds true for highly crosslinked liners, particularly with long-term follow-up, is still controversial. The effect of liner thickness on wear of highly cross-linked liners also remains to be clarified.This study sought to determine (1) the long-term clinical and radiological performance of highly cross-linked polyethylene in THA and (2) the effect of acetabular component positioning, polyethylene thickness, and patient demographics on wear.

Methods

Ninety-three THAs using a 28-mm hip ball, single brand of highly cross-linked polyethylene liner, and cementless cup were performed in 87 patients. Clinical outcomes were evaluated using the Harris Hip Score and need for revision surgery. Linear and volumetric wear, presence of osteolysis, and cup abduction angle were assessed.

Results

The mean age at operation was 51.4 years. The mean duration of follow-up was 12.7 years (10-16 years). Patients aged >50 years had higher rates of linear wear than those aged <50 years (P = .015). Positive correlation was found between cup abduction angle (P = .014) and cup version (P = .035) with a linear wear rate. Thinner liners (≤7 mm) had similar rates of linear and volumetric wear as thicker liners (≥8 mm) (P = .447).

Conclusion

This is the only study to demonstrate a positive significant relationship between cup abduction angle and version with linear wear rate in THA with at least 10 years of follow-up. Liner thickness was not found to affect wear rates.

Section snippets

Patients and Methods

This study received approval from the local institutional review board. From April 2001 to December 2007, a total of 230 total hip arthroplasties were performed in our institution. After excluding arthroplasties performed using other bearing couplings, brands of liner and different hip ball sizes, a total of 151 THAs performed using 28-mm hip balls and Marathon liners were left. After exclusion of those with inadequate radiological and clinical follow-up, the remaining cohort consisted of 93

Clinical Results

The mean duration of follow-up was 12.7 years (range: 10-16). The Harris Hip Score improved significantly from a mean of 46.02 before operation to a mean of 88.6 at the latest follow-up visit (P < .0001). The pain component of Harris Hip Score improved from a mean of 17.6 before operation to 43 at the latest follow-up visit (P < .0001). No patients complained of significant pain over the operated extremity which hindered their ability to ambulate.

One patient had aseptic loosening of the

Discussion

An important finding of this study is that there is a positive significant correlation between acetabular component abduction angle and linear wear rate of highly cross-linked liners over a long duration of follow-up. This relationship has been well established for conventional polyethylene liners [9], [10], [17]. Prior studies examining this in HXLPE with long-term follow-up have been unable to demonstrate a significant relationship between acetabular abduction angle and linear wear [12], [13]

Acknowledgments

The authors would like to thank Miss Bernice Leung, Miss Tegan Ho, Mr. Lison Fung and Miss Vivian Chan for their contributions in data collection and record retrieval.

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      Hence, it is vital to consider the mechanical and tribological properties of thinner HXLPE. On the tribological front, while the results of simulator studies on the relationship between HXLPE thickness and their wear rate are inconsistent, medium term clinical studies have not found significantly more wear of thinner HXLPE liners [14,23,24]. On the mechanical front, several cases of rim fracture of thin HXLPE liners have been reported [25,26], often in the presence of other risk factors such as obesity, poor snap-fit of the liner, cup verticalization, impingement with the prosthetic neck.

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.04.041.

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