In an OrthoBuzz post last year titled “Has Conventional Polyethylene Become Obsolete?,” we featured results from a small randomized trial that documented much-improved implant survival over 10 years with acetabular components made from cross-linked polyethylene (XLPE) compared with conventional polyethylene (CPE). In the August 1, 2018 issue of The Journal, we find further corroboration of the benefits realized by patients who receive XLPE acetabular components.
deSteiger et al. analyzed registry data involving more than 240,000 total hip arthroplasty (THA) patients and found markedly lower revision rates in those who received XPLE rather than CPE acetabular components. At a mean follow-up of 16 years, the cumulative percentage of revisions was 6.2% in the XPLE group versus 11.7% in the CPE group. Among patients <55 years of age at the time of THA, at 7 years there was a five-fold increase in revision rates for procedures done with CPE compared to those done with XLPE.
Because the authors observed that the between-group differences in revision rates became more pronounced over time, it is possible that this difference will continue to grow as more data is gathered. When we consider the vast number of THAs performed around the world each year, this XLPE-related decrease in revision rate could have a beneficial impact on millions of patients.
The documented success so far of XPLE is a clear case where understanding the nature of the original problem (polyethylene wear) and applying consistent and innovative research to find a solution have allowed patients worldwide to reap the benefits associated with THA, with some assurance that their hip replacement may, in fact, last for their rest of their life.
Marc Swiontkowski, MD