title: Reasons for revision of first-generation highly cross-linked polyethylenes.
abstract: Over a 10-year period, we prospectively evaluated the reasons for revision of contemporary and highly cross-linked polyethylene formulations in amulticenter retrieval program. Two hundred twelve consecutive retrievals were classified as conventional gamma inert sterilized (n = 37), annealed (Cross fire,[Stryker Orthopedics, Mahwah, NJ] n = 72), or remelted (Longevity [Zimmer ,Warsaw, Ind], XLPE[Smith and Nephew, Memphis, Tenn], Durasul [Zimmer,Warsaw, Ind] n = 103) liners. The most frequent reasons for revision were loosening (35%), instability(28%), and infection (21%) and were not related to polyethylene formulation (P = .17). Annealed and remelted liners had comparable linear penetration rates(0.03 and 0.04 mm/y, respectively, on average), and these were significantly lower than the rate in conventional retrievals (0.11 mm/y, P ≤ .0005). This retrieval study including first-generation highly cross linked liners demonstrated lower wear than conventional polyethylene. Although loosening remained as the most prevalent reason for revision, we could not demonstrate a relationship between wear and loosening.The long-term clinical performance of first-generation highly cross-linked liners remains promising based on the midterm outcomes of the components documented in this study [corrected].
authors.affiliation: Implant Research Center, School of Biomedical Engineering, Science, and Heath Systems, Drexel University, Philadelphia, Pennsylvania, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kurtz
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Medel
authors.forename: Daniel W
authors.initials: DW
authors.lastname: MacDonald
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kraay
authors.forename: Clare M
authors.initials: CM
authors.lastname: Rimnac
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D007593:Joint Instability / Q000150:complications; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000150:complications; D011095:Polyethylenes; D011475:Prosthesis Failure / Q000009:adverse effects / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000150:complications; D012086:Reoperation
chemical_list: D011095:Polyethylenes