The incidence of acetabular osteolysis in young patients with conventional versus highly crosslinked polyethylene.
BACKGROUND
Osteolysis is a major mode of hip implant failure. Previous literature has focused on the amount of polyethylene wear comparing highly crosslinked polyethylene (HXPLE) with conventional liners but has not clarified the relative incidence of osteolysis with these two liners.


OBJECTIVE
We determined (1) the incidence of osteolysis in HXLPE versus conventional polyethylene (CPE), (2) the ability to detect and evaluate the size of lytic lesions using radiographs compared with CT scans, (3) head penetration in hips without and with lysis, and (4) determined whether acetabular position, head size, and UCLA activity score contributed to lysis.


METHODS
We compared head penetration and osteolysis on plain radiographs and presence and volume of osteolysis on CT scans in 48 patients with HXLPE (mean, 46.5 years) and 50 patients with CPE (mean, 43.2 years). The minimum followup was 5 years (average, 7.2 years; range, 5.1-10.9 years),


RESULTS
Osteolysis was apparent on CT in a larger number of patients with CPE liners than HXLPE liners: 12 of 50 (24%) versus one of 48 (2%), respectively. We found no correlation between head penetration and volume of osteolytic lesions. Head penetration was greater in patients with osteolysis. Smaller head sizes were associated with greater wear and those with osteolysis had smaller head sizes; however, there was no difference in acetabular component position or UCLA activity in those with lysis compared with those without.


CONCLUSIONS
HXLPE diminished the incidence of osteolysis, but the lack of correlation between penetration and volume of osteolysis suggests other factors other than wear contribute to the development of osteolysis.


METHODS
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Mall
Nathan A
NA
Department of Orthopedics, Washington University School of Medicine, Barnes-Jewish Hospital, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO 63110, USA.
Nunley
Ryan M
RM
Zhu
Jin Jun
JJ
Maloney
William J
WJ
Barrack
Robert L
RL
Clohisy
John C
JC
D000077:Acetabulum / Q000473:pathology*; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D003432:Cross-Linking Reagents; D019544:Equipment Failure Analysis; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000473:pathology; D006621:Hip Joint / Q000473:pathology* / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000209:etiology*; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012189:Retrospective Studies
D003432:Cross-Linking Reagents; D020959:Polyethylene
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