Abstract
ObjectiveTo compare the wear of conventional ultra-high molecular weight polyethylene (CUHMWPE) and highly cross-linked polyethylene (HCLPE) in hip revision with liner exchange fixed with original locking mechanism using analysis of history medical data.MethodsFrom Jan. 1, 2000, to Dec. 31, 2007, 26 patients (with 29 involved hips) underwent liner exchange revision fixed with the original locking mechanism due to wear of CUHMWPE and/or osteolysis. The mean age was 53 ± 9 years at the time of the primary total hip arthroplasty (THA) and 64 ± 9 years at the revision. The exchanged liners (Marathon, Depuy) were made of HCLPE. Annual X-rays were used to measure linear wear and osteolysis. The annual linear penetration was measured using PolyWare® software (Draftware Inc.). Annual Harris Hip Scores(HSS) were recorded.ResultsThe mean follow-up time between the primary and revision THAs was 11 ± 2 years and 8 ± 2 years after revision. The mean Harris Hip Score(HHS) before primary THA, 1 year after primary THA, before revision and 1 year after revision was 43±5, 85±5, 71±6, 83±7 individually. The mean penetration of the CUHMWPE and HCLPE liners occurring in the first year were 0.44 ± 0.28 mm and 0.38 ± 0.14 mm, respectively (p = 0.211). The mean annual linear penetration of CUHMWPE and HCLPE from the second year onward were 0.29±0.09 mm and 0.08 ± 0.03 mm respectively (p <0.01). All THAs with CUHMWPE showed osteolysis on acetabular and/or femoral side before revision. No HCLPE liner showed osteolysis at the last follow-up. Conclusion: The CUHMWPE liner had a significantly higher wear rate than did the HCLPE liner. The HCLPE liner showed a satisfactory liner penetration rate after revision with isolated liner exchange fixed with the original locking mechanism.
Highlights
Total hip arthroplasty (THA) is the most effective treatment method for advanced hip diseases
From Jan. 1, 2000, to Dec. 31, 2007, 26 patients underwent liner exchange revision fixed with the original locking mechanism due to wear of conventional ultra-high molecular weight polyethylene (CUHMWPE) and/or osteolysis
The mean penetration of the CUHMWPE and highly cross-linked polyethylene (HCLPE) liners occurring in the first year were 0.44 ± 0.28 mm and 0.38 ± 0.14 mm, respectively (p = 0.211)
Summary
Total hip arthroplasty (THA) is the most effective treatment method for advanced hip diseases. Wear particles from polyethylene implants play an important role in the development of periprosthetic osteolysis, which can lead to prosthetic failure. Different types of modifications, including carbon-reinforced, highly crystalline, acetylene cross-linked, and high cross-linked, have been undertaken to improve the clinical performance of conventional ultra-high molecular weight polyethylene (CUHMWPE) since it was first used by John Charnley in 1962 [2]. Various of highly cross-linked polyethylene (HCLPE) liners (such as Marathon, Depuy; X3, Stryker; Longevity, Zimmer; XLPE, Smith and Nephew; and Acrom XL, Biomet) have been used extensively to decrease wear, osteolysis and related implant failures in THA. Studies[3,4,5] have shown that HCLPE has much less wear and osteolysis than does CUHMWPE. Long-term result of HCLPE in revision THA is unknown
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