CORR Insights ®: Metal-on-conventional total hip arthroplasty bearing surfaces have a higher risk of revision than metal-on-highly crosslinked polyethylene: results from a US registry.

Abstract

H ighly crosslinked polyethylene (XLPE) has essentially supplanted conventional polyethylene for use in total hip arthroplasty (THA) during the past decade. There now exists good evidence to demonstrate a clear reduction in femoral head penetration (and presumably polyethylene wear) and periprosthetic osteolysis associated with the use XLPE compared to conventional polyethylene in THA [2, 3]. While the annual reports of Australian Orthopaedic Association National Joint Replacement Registry continue to show the clinical benefits of XLPE (demonstrating a reduction in revision rates) [1], other investigators have not demonstrated a clear reduction in revision rates with the use of XLPE at mid-term followup [4]. The current study by Paxton and colleagues attempts to demonstrate the clinical benefits resulting from the use of XLPE compared to conventional polyethylene through the analysis of a large US-based patient database. Their findings demonstrate that, for two specific implant designs, the revision rate was significantly decreased for XLPE compared to the use of conventional polyethylene. Therefore, this work essentially confirms the experience reported by the Australian Orthopaedic Association National Joint Replacement Registry during the past decade. While important work, this study is limited by the observational nature of the study, inherent to all registry or database analysis, and only provides information about two specific hip designs (both of which having been replaced by more recent designs by their respective manufacturers). Furthermore, analysis of this type does not provide any radiological, functional or patient-derived outcomes This CORR Insights is a commentary on the article ‘‘Metal-on-conventional Total Hip Arthroplasty Bearing Surfaces Have a Higher Risk of Revision Than Metal-on-highly Crosslinked Polyethylene: Results From a US Registry’’ by Paxton and colleagues available at: DOI: 10.1007/s11999-014-4105-9 The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or the Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0144105-9