History and Systematic Review of Wear and Osteolysis Outcomes for First-generation Highly Crosslinked Polyethylene
Top Cited Papers
Open Access
- 1 August 2011
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics and Related Research
- Vol. 469 (8), 2262-2277
- https://doi.org/10.1007/s11999-011-1872-4
Abstract
Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and osteolysis in total joint arthroplasty. While many studies report wear and osteolysis associated with HXLPE, analytical techniques, clinical study design and followup, HXLPE formulation and implant design characteristics, and patient populations differ substantially among investigations, complicating a unified perspective. Literature on first-generation HXLPE was summarized. We systematically reviewed the radiographic wear data and incidence of osteolysis for HXLPE in hip and knee arthroplasty. PubMed identified 391 studies; 28 met inclusion criteria for a weighted-averages analysis of two-dimensional femoral head penetration rates. To determine the incidence of osteolysis, we estimated a pooled odds ratio using a random-effects model. Weighted-averages analyses of femoral head penetration rates in HXLPE liners and conventional UHMWPE liners resulted, respectively, in a mean two-dimensional linear penetration rate of 0.042 mm/year based on 28 studies (n = 1503 hips) and 0.137 mm/year based on 18 studies (n = 695 hips). The pooled odds ratio for the risk of osteolysis in HXLPE versus conventional liners was 0.13 (95% confidence interval, 0.06–0.27) among studies with minimum 5-year followup. We identified two clinical studies of HXLPE in TKA, preventing systematic analysis of outcomes. HXLPE liner studies consistently report lower femoral head penetration and an 87% lower risk of osteolysis. Reduction in femoral head penetration or osteolysis risk is not established for large-diameter (> 32 mm) metallic femoral heads or ceramic femoral heads of any size. Few studies document the clinical performance of HXLPE in knees.Keywords
This publication has 136 references indexed in Scilit:
- Do First-generation Highly Crosslinked Polyethylenes Oxidize In Vivo?Clinical Orthopaedics and Related Research, 2011
- The Incidence of Acetabular Osteolysis in Young Patients With Conventional versus Highly Crosslinked PolyethyleneClinical Orthopaedics and Related Research, 2011
- Do “Premium” Joint Implants Add Value?: Analysis of High Cost Joint Implants in a Community RegistryClinical Orthopaedics and Related Research, 2011
- Highly Crosslinked Polyethylene Reduces Wear in Total Hip Arthroplasty at 5 YearsClinical Orthopaedics and Related Research, 2010
- Femoral Head Size and Wear of Highly Cross-linked Polyethylene at 5 to 8 YearsClinical Orthopaedics and Related Research, 2009
- THA with Highly Cross-linked Polyethylene in Patients 50 Years or YoungerClinical Orthopaedics and Related Research, 2009
- A systematic review of radiological outcomes of highly cross-linked polyethylene versus conventional polyethylene in total hip arthroplastyInternational Orthopaedics, 2009
- Wear Analysis in THA Utilizing Oxidized Zirconium and Crosslinked PolyethyleneClinical Orthopaedics and Related Research, 2009
- Wear is Reduced in THA Performed with Highly Cross-linked PolyethyleneClinical Orthopaedics and Related Research, 2008
- Highly Crosslinked Polyethylene is Safe for Use in Total Knee ArthroplastyClinical Orthopaedics and Related Research, 2008