Has Conventional Polyethylene Become Obsolete in THA?

Highly cross-linked polyethylene (XLPE) has been in clinical use for nearly 15 years. In acetabular components for total hip arthroplasty (THA), XLPE’s superior wear characteristics and lower revision rates, relative to conventional polyethylene (PE), have been demonstrated in numerous studies. Here is one more: a 10-year Level I study in the October 18, 2017 issue of The Journal of Bone & Joint Surgery by Devane et al.

In this double-blinded, randomized trial, authors measured 2-D, 3-D, and volumetric wear (in mm or mm²), along with wear rates (mm/year), presence or absence of osteolysis, and revision rates in 91 patients at specified time intervals, up to a minimum of 10 years. The following results corroborate the general findings from most other studies on this topic:

• The mean 3-D wear rate among patients with the XLPE acetabular liner was 0.03 mm/yr, versus 0.27 mm/yr among patients with conventional PE.
• Eight percent of patients in the XLPE group showed radiographic evidence of osteolysis, versus 38% of patients in the PE group.
• Patients with the conventional PE liner had a significantly higher revision rate (14.6%) than those with the XLPE liner (1.9%).

There were no significant between-group differences in clinical outcome scores, including the Oxford Hip Score and SF-12 physical well-being score.

The authors note that “the longer-term implications of these findings are unclear,” but their calculations indicated that, through 20 years, none of the XLPE liners would wear through, but 6 of the conventional PE liners would require revision due to wear-through.