Abstract
BackgroundHighly cross-linked polyethylene (HXLPE) has been reported as an effective material for decreasing polyethylene wear and osteolysis in total knee arthroplasty (TKA). Because no single study to date has been large enough to definitively determine the benefit of HXLPE in TKA, we conducted a meta-analysis to pool the results from randomized controlled trials (RCTs) and non-RCTs to make such a determination.MethodsPotential candidate articles were identified by searching the Cochrane Library, Medline (1966-2015.10), PubMed (1966-2015.10), Embase (1980-2015.10), ScienceDirect (1985-2015.10), and other databases. “Gray studies” were identified from the included articles’ reference lists. Pooled data were analyzed using RevMan 5.1.ResultsThree RCTs and three non-RCTs were included in the meta-analysis. There were no significant differences between the groups in the total number of reoperations (P = 0.11), reoperations for prosthesis loosening (P = 0.08), radiolucent line (P = 0.20), osteolysis (P = 0.38), prosthesis loosening (P = 0.10), and mechanical failures related to the tibial polyethylene (P = 1.00). Similarly, no significant differences between the two groups were found in postoperative total knee score (P = 0.18) or functional score (P = 0.23).ConclusionsThe meta-analysis showed that compared with conventional polyethylene, HXLPE did not improve the clinical and radiographic outcomes in mid-term follow-up after TKA. Additional high-quality multicenter prospective RCTs with good design, large study populations and long-term follow-up will be necessary to further clarify the effect of HXLPE in TKA.
Highlights
Cross-linked polyethylene (HXLPE) has been reported as an effective material for decreasing polyethylene wear and osteolysis in total knee arthroplasty (TKA)
HXLPE acetabular liners for total hip arthroplasty (THA) have successfully decreased linear wear and resulted in less osteolysis compared with conventional polyethylene (CP) [14, 15]
Inclusion criteria Studies were considered eligible for inclusion if they met the following criteria: (1) the patients underwent primary TKA; (2) the intervention was the use of HXLPE compared to CP (Table 1); (3) the outcomes included clinical outcomes, radiographic outcomes, complication, and revision reason; and (4) the study was a published or unpublished controlled clinical trial
Summary
Cross-linked polyethylene (HXLPE) has been reported as an effective material for decreasing polyethylene wear and osteolysis in total knee arthroplasty (TKA). Prosthesis loosening and osteolysis are major complications affecting the long-term survival of total knee prostheses [1, 2]. Many studies have been conducted to introduce new designs and materials to reduce polyethylene wear and osteolysis with a goal of achieving better long-term results. Several high-quality studies indicated that the mobile-bearing designs did not result in better radiographic and clinical TKA outcomes. HXLPE acetabular liners for total hip arthroplasty (THA) have successfully decreased linear wear and resulted in less osteolysis compared with conventional polyethylene (CP) [14, 15]. The process of cross-linking the polyethylene to improve wear had the
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