Continued improved wear with an annealed highly cross-linked polyethylene

William Capello, James A. D'Antonio, Rama Ramakrishnan, Marybeth Naughton

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background: Highly cross-linked polyethylene (HXLPE), created by disrupting the molecular structure of polyethylene, then through the application of heat, encourages creation of new cross-links in the process, resulting in a material with improved wear resistance. The impetuses for this new technology were the unsatisfactory wear properties and subsequent osteolysis of noncross-linked polyethylene. A 72% reduction in wear using highly cross-linked polyethylenes (HXLPE) compared with conventional polyethylene at 5 years was described previously. The longest term followup studies on HXLPE range from 2 to 6 years. Questions/purposes: We therefore addressed the following questions: (1) Does the improvement in wear observed at the earlier followup continue to 7 to 10 years? (2) What is the incidence of osteolysis in this group of patients and in the control group? Methods: We retrospectively reviewed 38 prospectively followed patients who had 42 hips with an annealed HXLPE who were followed a minimum of 7 years (average, 8.6 years; SD = 1; range, 7-10.3 years). Wear and osteolysis were compared with those of a control group of 39 patients (40 hips) from a US Investigational Device Exemption (IDE) prospective, randomized study begun in 1996 with conventional polyethylene and followed for a minimum of 6 years (average, 7.5 years; SD = 1.1; range, 6-10.2 years). Linear head penetration was measured from AP radiographs at early, 1-year, 5-year, and most recent followups. Results: At the average followup, annual linear wear was 0.031 mm (SD = 0.014) for the HXLPE and 0.141 mm (SD = 0.080) for the control group, a 78% reduction. No mechanical failure of the polyethylene was noted in either group. Incidence of osteolysis was 50% in the control group (all lesions confined to proximal Gruen Zones 1 and 7) compared with no cases in the investigational group. Conclusions: We observed an improvement in wear and no mechanical failures with this annealed material. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)825-830
Number of pages6
JournalClinical Orthopaedics and Related Research
Volume469
Issue number3
DOIs
StatePublished - Mar 2011

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Polyethylene
Osteolysis
Control Groups
Hip
Polyethylenes
Incidence
Molecular Structure
Hot Temperature
Head
Prospective Studies
Guidelines
Technology
Equipment and Supplies

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Continued improved wear with an annealed highly cross-linked polyethylene. / Capello, William; D'Antonio, James A.; Ramakrishnan, Rama; Naughton, Marybeth.

In: Clinical Orthopaedics and Related Research, Vol. 469, No. 3, 03.2011, p. 825-830.

Research output: Contribution to journalArticle

Capello, William ; D'Antonio, James A. ; Ramakrishnan, Rama ; Naughton, Marybeth. / Continued improved wear with an annealed highly cross-linked polyethylene. In: Clinical Orthopaedics and Related Research. 2011 ; Vol. 469, No. 3. pp. 825-830.
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abstract = "Background: Highly cross-linked polyethylene (HXLPE), created by disrupting the molecular structure of polyethylene, then through the application of heat, encourages creation of new cross-links in the process, resulting in a material with improved wear resistance. The impetuses for this new technology were the unsatisfactory wear properties and subsequent osteolysis of noncross-linked polyethylene. A 72{\%} reduction in wear using highly cross-linked polyethylenes (HXLPE) compared with conventional polyethylene at 5 years was described previously. The longest term followup studies on HXLPE range from 2 to 6 years. Questions/purposes: We therefore addressed the following questions: (1) Does the improvement in wear observed at the earlier followup continue to 7 to 10 years? (2) What is the incidence of osteolysis in this group of patients and in the control group? Methods: We retrospectively reviewed 38 prospectively followed patients who had 42 hips with an annealed HXLPE who were followed a minimum of 7 years (average, 8.6 years; SD = 1; range, 7-10.3 years). Wear and osteolysis were compared with those of a control group of 39 patients (40 hips) from a US Investigational Device Exemption (IDE) prospective, randomized study begun in 1996 with conventional polyethylene and followed for a minimum of 6 years (average, 7.5 years; SD = 1.1; range, 6-10.2 years). Linear head penetration was measured from AP radiographs at early, 1-year, 5-year, and most recent followups. Results: At the average followup, annual linear wear was 0.031 mm (SD = 0.014) for the HXLPE and 0.141 mm (SD = 0.080) for the control group, a 78{\%} reduction. No mechanical failure of the polyethylene was noted in either group. Incidence of osteolysis was 50{\%} in the control group (all lesions confined to proximal Gruen Zones 1 and 7) compared with no cases in the investigational group. Conclusions: We observed an improvement in wear and no mechanical failures with this annealed material. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.",
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