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Highly crosslinked polyethylene liners may yield less linear, volumetric wear at 15 years
Patients with conventional polyethylene liners had higher revision rates vs patients with highly crosslinked polyethylene liners.
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ORLANDO — Results presented at the Current Concepts in Joint Replacement Winter Meeting showed patients undergoing total hip arthroplasty who received highly crosslinked polyethylene liners experienced less long-term linear and volumetric wear compared with conventional polyethylene liners
“Conventional polyethylene, while used 15 to 20 years ago as the predominant bearing, has gone out of favor,” Jeffrey B. Stambough, MD, co-author of the study which received the Orthopaedic Research and Education Foundation/CCJR Clinical Award, told Orthopedics Today. “This supports the use of more modern highly crosslinked bearings, especially in young patients who have longer life expectancies and higher activities,” he said.
Stambough and his colleagues retrospectively reviewed 212 patients 50 years of age or younger who underwent THA and received cobalt chrome heads (Zimmer) with either a conventional polyethylene liner (Trilogy, Zimmer) or highly crosslinked polyethylene liner (Longevity Highly Crosslinked Polyethylene, Zimmer).
Researchers collected patient-reported outcome measures, including the University of California, Los Angeles (UCLA) Activity, SF-12 and modified Harris Hip Scores, and used the Martell Hip Analysis Suite to calculate wear.
Patients in the highly crosslinked polyethylene group had significant improvements in UCLA activity and SF-12 physical function scores at 15-year follow-up.
Source: Jeffrey B. Stambough, MD
“Looking at conventional vs. highly crosslinked poly at 15 years, you can see there is a 10-times increase in linear wear in the conventional group compared to the highly crosslinked group,” Stambough said.
The conventional polyethylene group had 7.5 times greater volumetric wear. Results showed all-cause survivorship of 81% and 97.8% in the conventional and highly crosslinked groups, respectively.
Stambough noted the conventional group experienced 22 revisions vs. two revisions in the highly crosslinked group with wear-related complications determined to be a main cause of revision in the conventional group.
“We found that patients, especially around an average of 15 years or later, were having higher revision rates for wear-related complications, like osteolysis, recurrent dislocations from advanced poly wear and femoral fractures through osteolytic lesions, ... in the conventional bearing group and that no patients [who] received highly crosslinked materials had discernable wear or any wear-related revision complications,” Stambough told Orthopedics Today.
“Patients who received conventional polyethylene necessitate long-term, close follow-up and surveillance because we found around the 15-year to 18-year time point there is a dramatic increase in wear-related complications that require revision or catastrophic failures that necessitate immediate revisions instead of planned revisions,” he said. “Monitoring these patients on an annual basis probably is what should be recommended.” – by Casey Tingle
- References:
- Stambough JB, et al. J Arthroplasty. 2018;doi:10.1016/j.arth.2018.08.019.
- Stambough JB. Paper 41. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 12-15, 2018; Orlando.
- For more information:
- Jeffrey B. Stambough, MD, can be reached at University of Arkansas for Medical Sciences, Department of Orthopaedics, 2 Shackleford W. Blvd., Little Rock, AR 72211; email: jstambough@uams.edu.
Disclosure: Stambough reports no relevant financial disclosures.