Highly crosslinked polyethylene is safe for use in total knee arthroplasty.
Highly cross-linked polyethylene (XLPE) has been used with good initial success in hip arthroplasty to reduce wear. However, the process of crosslinking reduces fracture toughness, raising concerns as to whether it can be safely used in total knee arthroplasty (TKA). We therefore asked whether XLPE can be used safely in TKA. We performed a retrospective review of 100 subjects receiving XLPE and compared them to 100 subjects who received standard polyethylene in the setting of TKA. The standard polyethylene group had a mean age of 70 with a minimum follow up of 82 months. The highly cross-linked polyethylene group had a mean age of 67 and a minimum follow up of 69 months (mean, 75 months; range, 69-82 months). On radiographic review, the standard group demonstrated 20 TKAs with radiolucencies; 4 of these had evidence of a loose tibial component. The standard group required three revisions related to loose tibial components. The XLPE group had 2 subjects that demonstrated radiolucencies on radiograph and no subjects with evidence of tibial loosening. There were no reoperations related to osteolysis. The data suggest XLPE in TKA can be used safely at least short- to midterm. Our study provides an impetus for further long-term investigation.


METHODS
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Hodrick
Jeffrey T
JT
Southern Joint Replacement Institute, Nashville, TN 37205, USA.
Severson
Erik P
EP
McAlister
Deborah S
DS
Dahl
Brian
B
Hofmann
Aaron A
AA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D003432:Cross-Linking Reagents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008422:Materials Testing / Q000379:methods; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D020959:Polyethylene / Q000737:chemistry* / Q000592:standards*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013314:Stress, Mechanical; D013499:Surface Properties; D013997:Time Factors; D016896:Treatment Outcome
D003432:Cross-Linking Reagents; D020959:Polyethylene
Clin Orthop Relat Res. 2004 Nov;(428):114-9
15534530
J Arthroplasty. 1996 Dec;11(8):974-6
8986578
Clin Orthop Relat Res. 2005 Nov;440:141-8
16239798
Clin Orthop Relat Res. 2004 Nov;(428):26-34
15534515
Instr Course Lect. 2004;53:251-9
15116619
Clin Orthop Relat Res. 2004 Dec;(429):68-72
15577468
J Bone Joint Surg Am. 2005 Feb;87(2):326-31
15687155
Clin Orthop Relat Res. 2001 Jul;(388):85-94
11451137
Clin Orthop Relat Res. 2001 Dec;(393):71-7
11764373
J Bone Joint Surg Am. 2000 Dec;82(12):1708-25
11130644
Clin Orthop Relat Res. 2007 Nov;464:16-20
18062044
J Arthroplasty. 1996 Jun;11(4):377-89
8792243
J Arthroplasty. 2005 Jun;20(4 Suppl 2):55-8
15991131
J Bone Joint Surg Am. 2003;85-A Suppl 1:S7-S13
12540663
Clin Orthop Relat Res. 2002 Nov;(404):89-95
12439243
Biomaterials. 2006 Apr;27(10):2275-84
16316683
J Am Acad Orthop Surg. 2007 Jan;15(1):53-64
17213382
J Bone Joint Surg Am. 2003 Mar;85(3):464-8
12637432
Clin Orthop Relat Res. 2004 Nov;(428):40-50
15534517
Instr Course Lect. 2004;53:261-4
15116620
J Orthop Res. 1999 Mar;17(2):157-67
10221831
J Bone Joint Surg Am. 2002 Aug;84(8):1362-71
12177266
J Arthroplasty. 2007 Apr;22(3):435-44
17400100
Clin Orthop Relat Res. 1999 Oct;(367):28-38
10546595
Int Orthop. 1992;16(4):349-58
1473888
Clin Orthop Relat Res. 2007 Dec;465:122-7
18090469
Instr Course Lect. 2004;53:243-9
15116618
J Arthroplasty. 2000 Aug;15(5):576-83
10959995
J Appl Biomater. 1994;5(3):185-90
10147443
Acta Orthop Scand. 2003 Oct;74(5):531-41
14620972
J Arthroplasty. 2005 Jun;20(4 Suppl 2):59-62
15991132
Clin Orthop Relat Res. 1998 Nov;(356):10-5
9917661
Clin Orthop Relat Res. 1994 Feb;(299):31-43
8119035
Clin Orthop Relat Res. 1996 Dec;(333):76-86
8981883
J Biomech. 2005 Feb;38(2):357-65
15598464
Orthop Clin North Am. 1998 Apr;29(2):361-71
9553582
Clin Orthop Relat Res. 1998 Nov;(356):170-80
9917682
Clin Orthop Relat Res. 2005 Nov;440:149-56
16239799
J Orthop Res. 2002 Sep;20(5):1038-41
12382971
Clin Orthop Relat Res. 2002 Nov;(404):7-13
12439231
Clin Orthop Relat Res. 1991 Aug;(269):120-7
1864029
Clin Orthop Relat Res. 2002 Nov;(404):102-7
12439246
J Bone Joint Surg Am. 2002 Oct;84(10):1849-55
12377918
J Bone Joint Surg Am. 2001 Nov;83(11):1660-5
11701788
J Biomech. 2005 Feb;38(2):315-22
15598459
J Arthroplasty. 1999 Jun;14(4):488-92
10428231
J Arthroplasty. 2004 Oct;19(7):887-97
15483806