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The Journal of Hip Surgery 2020; 4(04): 158-165
DOI: 10.1055/s-0040-1716576
Original Article

Are the Wear and Osteolysis Outcomes Different between Annealed and Remelted First-Generation Highly Crosslinked Polyethylene after Long-Term Implantation?

Jaclyn T. Schachtner
1   Department of Biomedical Engineering, Exponent Inc., Philadelphia, Pennsylvania
,
Daniel W. MacDonald 
2   Implant Research Core, Drexel University School of Biomedical Engineering Science and Health Systems, Philadelphia, Pennsylvania
,
Gregg R. Klein
3   Department of Orthopaedic Surgery, Rothman Institute, Montvale, New Jersey
,
Arthur L. Malkani 
4   Department of Orthopedics, University of Louisville, Louisville, Kentucky
,
Matthew Kraay
5   Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio
,
Clare M. Rimnac
6   Center for the Evaluation of Implant Performance, Case Western Reserve University Case School of Engineering, Cleveland, Ohio
,
Michael A. Mont
7   Department of Orthopaedic Surgery, Lenox Hill Hospital at Northwell Health, New York City, New York
,
Gwo-Chin Lee
8   Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
,
Steven Michael Kurtz
1   Department of Biomedical Engineering, Exponent Inc., Philadelphia, Pennsylvania
2   Implant Research Core, Drexel University School of Biomedical Engineering Science and Health Systems, Philadelphia, Pennsylvania
› Author Affiliations Funding This study was supported by the U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AR47904).
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Abstract

First-generation highly crosslinked polyethylene (HXLPE) was developed to reduce polyethylene wear debris and subsequent osteolysis. Two thermal stabilization strategies were developed, annealing and remelting, to remove free radicals remaining in the polymer. Both types of HXLPEs have demonstrated better wear resistance to conventional polyethylene in hip arthroplasty. However, few studies have directly compared the mid- to long-term clinical outcomes of first-generation HXLPEs. We sought to address the following research questions: (1) is there a difference between the revision reasons for HXLPE formulations (annealed and remelted), (2) is there a difference in oxidation between annealed and remelted HXLPEs, (3) is there a difference in the linear penetration rate of annealed and remelted HXLPEs, and (4) does the formulation of first-generation HXLPEs affect the prevalence of osteolysis? A total of 129 first-generation HXLPE acetabular liners were collected in a multicenter retrieval program. These components were implanted for 5 or more years and were fabricated from annealed or remelted HXLPE. Reasons for revision, body mass index, age, sex, and activity levels were collected from medical records. Oxidation was measured at four regions of interest: bearing surface, backside surface, locking mechanism, and rim. Liner penetration was directly measured from retrievals using a micrometer. Osteolysis was reported in the operative notes by the revising surgeon and a thorough review of the operative notes and radiographs. Revision reasons included infection, instability, pain, and loosening. The annealed liners had higher oxidation indices than remelted liners. There was no difference in linear penetration rates between cohorts. There was no difference in osteolysis prevalence between cohorts. We found remelted HXLPE to be more oxidatively stable than annealed HXLPE but did not find a significant difference in the linear penetration rates or the prevalence of osteolysis. Our findings demonstrate sustained long-term wear resistance of both cohorts of HXLPE. We did not find evidence to support a long-term clinical difference between the formulations of HXLPE.

Keywords

first-generation HXLPE - osteolysis - wear - total hip arthroplasty - oxidation


Publication History

Received: 15 May 2020

Accepted: 21 July 2020

Article published online:
17 September 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kurtz SM. UHMWPE Biomaterials Handbook: Ultra High Molecular Weight Polyethylene in Total Joint Replacement and Medical Devices. London: Academic Press; 2009
    Search in Google Scholar
  • 2 Kurtz SM, Hozack W, Turner J. et al. Mechanical properties of retrieved highly cross-linked crossfire liners after short-term implantation. J Arthroplasty 2005; 20 (07) 840-849
    CrossrefPubMedSearch in Google Scholar
  • 3 Kurtz SM, Gawel HA, Patel JD. History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Relat Res 2011; 469 (08) 2262-2277
    CrossrefPubMedSearch in Google Scholar
  • 4 Wannomae KK, Bhattacharyya S, Freiberg A, Estok D, Harris WH, Muratoglu O. In vivo oxidation of retrieved cross-linked ultra-high-molecular-weight polyethylene acetabular components with residual free radicals. J Arthroplasty 2006; 21 (07) 1005-1011
    CrossrefPubMedSearch in Google Scholar
  • 5 Atwood SA, Van Citters DW, Patten EW, Furmanski J, Ries MD, Pruitt LA. Tradeoffs amongst fatigue, wear, and oxidation resistance of cross-linked ultra-high molecular weight polyethylene. J Mech Behav Biomed Mater 2011; 4 (07) 1033-1045
    CrossrefPubMedSearch in Google Scholar
  • 6 Capello WN, D'Antonio JA, Ramakrishnan R, Naughton M. Continued improved wear with an annealed highly cross-linked polyethylene. Clin Orthop Relat Res 2011; 469 (03) 825-830
    CrossrefPubMedSearch in Google Scholar
  • 7 Thomas GE, Simpson DJ, Mehmood S. et al. The seven-year wear of highly cross-linked polyethylene in total hip arthroplasty: a double-blind, randomized controlled trial using radiostereometric analysis. J Bone Joint Surg Am 2011; 93 (08) 716-722
    CrossrefPubMedSearch in Google Scholar
  • 8 Engh Jr CA, Hopper Jr RH, Huynh C, Ho H, Sritulanondha S, Engh Sr CA. A prospective, randomized study of cross-linked and non-cross-linked polyethylene for total hip arthroplasty at 10-year follow-up. J Arthroplasty 2012; 27 (08) 2-7.e1
    CrossrefPubMedSearch in Google Scholar
  • 9 Kurtz SM, Austin MS, Azzam K. et al. Mechanical properties, oxidation, and clinical performance of retrieved highly cross-linked Crossfire liners after intermediate-term implantation. J Arthroplasty 2010; 25 (04) 614-23.e1 , 2
    CrossrefPubMedSearch in Google Scholar
  • 10 James SP, Blazka S, Merrill EW. et al. Challenge to the concept that UHMWPE acetabular components oxidize in vivo. Biomaterials 1993; 14 (09) 643-647
    CrossrefPubMedSearch in Google Scholar
  • 11 International A. Standard Guide for Evaluating the Extent of Oxidation in Polyethylene Fabricated Forms Intended for Surgical Implants. Vol ASTM Standard F2101–13. West Conshohocken, PA: ASTM; 2013
    Search in Google Scholar
  • 12 Gómez-Barrena E, Li S, Furman BS, Masri BA, Wright TM, Salvati EA. Role of polyethylene oxidation and consolidation defects in cup performance. Clin Orthop Relat Res 1998; (352) 105-117
    PubMedSearch in Google Scholar
  • 13 Kurtz SM, MacDonald DW, Mont MA, Parvizi J, Malkani AL, Hozack W. Retrieval analysis of sequentially annealed highly crosslinked polyethylene used in total hip arthroplasty. Clin Orthop Relat Res 2015; 473 (03) 962-971
    CrossrefPubMedSearch in Google Scholar
  • 14 Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 2009; 91 (01) 128-133
    Search in Google Scholar
  • 15 Tower SS, Currier JH, Currier BH, Lyford KA, Van Citters DW, Mayor MB. Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg Am 2007; 89 (10) 2212-2217
    CrossrefPubMedSearch in Google Scholar
  • 16 Halley D, Glassman A, Crowninshield RD. Recurrent dislocation after revision total hip replacement with a large prosthetic femoral head. A case report. J Bone Joint Surg Am 2004; 86 (04) 827-830
    CrossrefPubMedSearch in Google Scholar
  • 17 Currier BH, Currier JH, Collier JP, Mayor MB. Effect of fabrication method and resin type on performance of tibial bearings. J Biomed Mater Res 2000; 53 (02) 143-151
    CrossrefPubMedSearch in Google Scholar
  • 18 Takada R, Jinno T, Koga D, Hirao M, Muneta T, Okawa A. Comparison of wear rate and osteolysis between annealed and remelted highly cross-linked polyethylene in total hip arthroplasty. A case control study at 7 to 10 years follow-up. Orthop Traumatol Surg Res 2016; 102 (06) 717-721
    CrossrefPubMedSearch in Google Scholar
  • 19 McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB, Chess DG, Charron KD. Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am 2009; 91 (04) 773-782
    CrossrefPubMedSearch in Google Scholar
  • 20 Haw JG, Battenberg AK, Huang DT, Schmalzried TP. Wear rates of larger-diameter cross-linked polyethylene at 5 to 13 years: does liner thickness or component position matter?. J Arthroplasty 2017; 32 (04) 1381-1386
    CrossrefPubMedSearch in Google Scholar
  • 21 Bitsch RG, Loidolt T, Heisel C, Ball S, Schmalzried TP. Reduction of osteolysis with use of Marathon cross-linked polyethylene. A concise follow-up, at a minimum of five years, of a previous report. J Bone Joint Surg Am 2008; 90 (07) 1487-1491
    CrossrefPubMedSearch in Google Scholar
  • 22 Babovic N, Trousdale RTMD. Total hip arthroplasty using highly cross-linked polyethylene in patients younger than 50 years with minimum 10-year follow-up. J Arthroplasty 2013; 28 (05) 815-817
    CrossrefPubMedSearch in Google Scholar
  • 23 Shia DS, Clohisy JC, Schinsky MF, Martell JM, Maloney WJ. THA with highly cross-linked polyethylene in patients 50 years or younger. Clin Orthop Relat Res 2009; 467 (08) 2059-2065
    CrossrefPubMedSearch in Google Scholar
  • 24 García-Rey E, García-Cimbrelo E, Cruz-Pardos A. New polyethylenes in total hip replacement: a ten- to 12-year follow-up study. Bone Joint J 2013; 95-B (03) 326-332
    CrossrefPubMedSearch in Google Scholar
  • 25 Cross MB, Nam D, Mayman DJ. Ideal femoral head size in total hip arthroplasty balances stability and volumetric wear. HSS J 2012; 8 (03) 270-274
    CrossrefPubMedSearch in Google Scholar
  • 26 Garvin KL, White TC, Dusad A, Hartman CW, Martell J. Low wear rates seen in THAs with highly crosslinked polyethylene at 9 to 14 years in patients younger than age 50 years. Clin Orthop Relat Res 2015; 473 (12) 3829-3835
    CrossrefPubMedSearch in Google Scholar
  • 27 Olyslaegers C, Defoort K, Simon JP, Vandenberghe L. Wear in conventional and highly cross-linked polyethylene cups: a 5-year follow-up study. J Arthroplasty 2008; 23 (04) 489-494
    CrossrefPubMedSearch in Google Scholar
  • 28 Dorr LD, Wan Z, Shahrdar C, Sirianni L, Boutary M, Yun A. Clinical performance of a Durasul highly cross-linked polyethylene acetabular liner for total hip arthroplasty at five years. J Bone Joint Surg Am 2005; 87 (08) 1816-1821
    PubMedSearch in Google Scholar
  • 29 Rajadhyaksha AD, Brotea C, Cheung Y, Kuhn C, Ramakrishnan R, Zelicof SBMDP. Five-year comparative study of highly cross-linked (crossfire) and traditional polyethylene. J Arthroplasty 2009; 24 (02) 161-167
    CrossrefPubMedSearch in Google Scholar
  • 30 Choi WK, Cho MR, Lee JH. Results of primary total hip arthroplasty with 36-mm femoral heads on highly cross-linked polyethylene-minimum seven-years follow-up. Hip Pelvis 2014; 26 (04) 220-226
    CrossrefPubMedSearch in Google Scholar
  • 31 Glyn-Jones S, Thomas GER, Garfjeld-Roberts P. et al. The John Charnley Award: highly crosslinked polyethylene in total hip arthroplasty decreases long-term wear: a double-blind randomized trial. Clin Orthop Relat Res 2015; 473 (02) 432-438
    CrossrefPubMedSearch in Google Scholar
  • 32 Gomez-Barrena E, Puertolas JA, Munuera L, Konttinen YT. Update on UHMWPE research: from the bench to the bedside. Acta Orthop 2008; 79 (06) 832-840
    CrossrefPubMedSearch in Google Scholar
  • 33 Huber M, Reinisch G, Zenz P, Zweymüller K, Lintner F. Postmortem study of femoral osteolysis associated with metal-on-metal articulation in total hip replacement: an analysis of nine cases. J Bone Joint Surg Am 2010; 92 (08) 1720-1731
    CrossrefPubMedSearch in Google Scholar
  • 34 Huddleston HD. Femoral lysis after cemented hip arthroplasty. J Arthroplasty 1988; 3 (04) 285-297
    CrossrefPubMedSearch in Google Scholar
  • 35 Ollivier M, Frey S, Parratte S, Flecher X, Argenson JN. Does impact sport activity influence total hip arthroplasty durability?. Clin Orthop Relat Res 2012; 470 (11) 3060-3066
    CrossrefPubMedSearch in Google Scholar