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The seven-year wear of highly cross-linked polyethylene in total hip arthroplasty: a double-blind, randomized controlled trial using radiostereometric analysis


Reference:

Thomas, G. E., Simpson, D. J., Mehmood, S., Taylor, A., McLardy-Smith, P., Gill, H. S., Murray, D. W. and Glyn-Jones, S., 2011. The seven-year wear of highly cross-linked polyethylene in total hip arthroplasty: a double-blind, randomized controlled trial using radiostereometric analysis. Journal of Bone and Joint Surgery, American Volume, 93 (8), pp. 716-722.

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http://dx.doi.org/10.2106/JBJS.J.00287

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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.

Details

Item Type Articles
CreatorsThomas, G. E., Simpson, D. J., Mehmood, S., Taylor, A., McLardy-Smith, P., Gill, H. S., Murray, D. W. and Glyn-Jones, S.
DOI10.2106/JBJS.J.00287
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URLURL Type
http://www.ncbi.nlm.nih.gov/pubmed/21508278PubMedCentral
DepartmentsFaculty of Engineering & Design > Mechanical Engineering
Research CentresCentre for Orthopaedic Biomechanics
RefereedYes
StatusPublished
ID Code30674
Additional InformationThomas, Geraint E R Simpson, David J Mehmood, Shahid Taylor, Adrian McLardy-Smith, Peter Singh Gill, Harinderjit Murray, David W Glyn-Jones, Sion Randomized Controlled Trial Research Support, Non-U.S. Gov't United States The Journal of bone and joint surgery. American volume J Bone Joint Surg Am. 2011 Apr 20;93(8):716-22.

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