History and Systematic Review of Wear and Osteolysis Outcomes for First-generation Highly Crosslinked Polyethylene

• Published in: Clinical orthopaedics and related research Vol. 469; no. 8; pp. 2262 - 2277
• Main Authors: Kurtz, Steven M., Gawel, Heather A., Patel, Jasmine D.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York Springer-Verlag 01.08.2011; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Arthroplasty (hip); Arthroplasty (knee); Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biological and medical sciences; Ceramics; Conservative Orthopedics; Cross-Linking Reagents; Data processing; Diseases of the osteoarticular system; Femur; Femur Head; Hip; Hip Prosthesis; Humans; Joints; Knee; Knee Prosthesis; Materials Testing; Medical sciences; Medicine; Medicine & Public Health; Orthopedics; Osteolysis; Osteolysis - prevention & control; Polyethylene; Polyethylenes - chemistry; Prosthesis Design; Prosthesis Failure; Reviews; Risk factors; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: UHMWPE for Arthroplasty: From Powder to Debris; Tibial Insert; Penetration Rate; UHMWPE; Femoral Head Size; Femoral Head; Polyethylene; Prognosis; Orthopedics; Wear; Review; Osteolysis; Case history; Bibliographic review
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-011-1872-4

Background 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. Questions/purposes 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. Methods 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. Results 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. Conclusions 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.