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Cross-linked Compared with Historical Polyethylene in THA: An 8-year Clinical Study

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Clinical Orthopaedics and Related Research

Abstract

Wear particle-induced osteolysis is a major cause of aseptic loosening in THA. Increasing wear resistance of polyethylene (PE) occurs by increasing the cross-link density and early reports document low wear rates with such implants. To confirm longer-term reductions in wear we compared cross-linked polyethylene (irradiation in nitrogen, annealing) with historical polyethylene (irradiation in air) in a prospective, randomized clinical study involving 48 patients who underwent THAs with a minimum followup of 7 years (mean, 8 years; range, 7–9 years). The insert material was the only variable. The Harris hip score, radiographic signs of osteolysis, and polyethylene wear were recorded annually. Twenty-three historical and 17 moderately cross-linked polyethylene inserts were analyzed (five patients died, three were lost to followup). At 8 years, the wear rate was lower for cross-linked polyethylene (0.088 ± 0.03 mm/year) than for the historical polyethylene (0.142 ± 0.07 mm/year). This reduction (38%) did not diminish with time (33% at 5 years). Acetabular cyst formation was less frequent (39% versus 12%), affected fewer DeLee and Charnley zones (17% versus 4%), and was less severe for the cross-linked polyethylene. The only revision was for an aseptically loose cup in the historical polyethylene group. Moderately cross-linked polyethylene maintained its wear advantage with time and produced less osteolysis, showing no signs of aging at mid-term followup.

Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Atrium Medisch Centrum, Heerlen, The Netherlands

    Carel H. Geerdink MD, Bernd Grimm PhD, Wendy Vencken, Ide C. Heyligers MD, PhD & Alphons J. Tonino MD, PhD

  2. Department of Orthopaedic Surgery, Ikazia Hospital, Montessoriweg 1, 3083 AN, Rotterdam, The Netherlands

    Carel H. Geerdink MD

Authors
  1. Carel H. Geerdink MD
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  2. Bernd Grimm PhD
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  3. Wendy Vencken
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  4. Ide C. Heyligers MD, PhD
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  5. Alphons J. Tonino MD, PhD
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Correspondence to Carel H. Geerdink MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Geerdink, C.H., Grimm, B., Vencken, W. et al. Cross-linked Compared with Historical Polyethylene in THA: An 8-year Clinical Study. Clin Orthop Relat Res 467, 979–984 (2009). https://doi.org/10.1007/s11999-008-0628-2

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  • DOI: https://doi.org/10.1007/s11999-008-0628-2

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