Abstract
PurposeHighly cross-linked polyethylene has been introduced to decrease osteolysis secondary to polyethylene wear debris generation. However, few long-term data on revision total hip arthroplasty (THA) using highly cross-linked polyethylene liners are available. The objective of this study was to determine long-term outcomes of a highly cross-linked polyethylene liner in revision THA.Materials & methodsWe evaluated 63 revision THAs performed in 63 patients using a highly cross-linked polyethylene liner between April 2000 and February 2005. Of these, nine died and four were lost to follow-up. Thus, the final study cohort consisted of 50 patients (50 hips), including 26 males and 24 females with a mean age of 53 years (range, 27–75 years). Mean follow-up was 11 years (range, 10–14 years).ResultsThe mean Harris hip score improved from 44 points preoperatively to 85 points at the final follow-up. No radiographic evidence of osteolysis was found in any hip. The mean rate of polyethylene liner wear was 0.029 mm/year (range, 0.003 to 0.098 mm/year). A total of 5 hips (10%) required re-revision arthroplasty, including one cup loosening, one recurrent dislocation, and three deep infections. Kaplan-Meier survivorship with an end point of re-revision for any reason was 91.1% and for aseptic cup loosening was 97.9% at 11 years.ConclusionAt a minimum of 10 years, the highly cross-linked polyethylene liners showed excellent clinical performance and implant survivorship, and were not associated with osteolysis in our patients with revision THAs.
Highlights
The clinical outcomes of revision total hip arthroplasty are often inferior to those obtained with primary total hip arthroplasty (THA) [1]
We reviewed the records of a consecutive series of patients with revision THA who had their hips replaced using highly cross-linked polyethylene (HXLPE) liners
We retrospectively evaluated 63 revision THAs performed in 63 patients using Longevity HXLPE liners between April 2000 and February 2005
Summary
The clinical outcomes of revision total hip arthroplasty are often inferior to those obtained with primary total hip arthroplasty (THA) [1]. Due to increasing numbers of patients undergoing THA and revision THA, improving the longevity of implant is highly desirable. Previous studies have clearly shown that HXLPE liners in primary THA have superior in vitro [5, 6] wear rates and midterm to long-term in vivo [7,8,9] wear rates. Feng et al [10] have shown excellent clinical results of cementless THAs using HXLPE liner with a mean 12.9year postoperative follow-up (range, 7–18 years), demonstrating the potential benefits of this new material in providing longevity even to revision settings. The long-term clinical results of HXLPE liner in revision THA are not well known because it is difficult to study a large cohort of patients with substantial clinically-rich information. We have been performing revision THAs routinely using electron beam-irradiated and melted HXLPE (Longevity; Zimmer, Warsaw, IN, USA) as an articulating liner with titanium acetabular cup to assure good performance even in revision settings
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