title: Highly cross-linked polyethylene decreases the rate of revision of total hip arthroplasty compared with conventional polyethylene at 13 years' follow-up.
abstract: OBJECTIVE
  The purpose of this study was to compare the long-term results of primary total hip arthroplasty (THA) in young patients using either a conventional (CPE) or a highly cross-linked (HXLPE) polyethylene liner in terms of functional outcome, incidence of osteolysis, radiological wear and rate of revision.
  
  
  METHODS
  We included all patients between the ages of 45 and 65 years who, between January 2000 and December 2001, had undergone a primary THA for osteoarthritis at our hospital using a CPE or HXLPE acetabular liner and a 28 mm cobalt-chrome femoral head. From a total of 160 patients, 158 (177 hips) were available for review (CPE 89; XLPE 88). The mean age, body mass index (BMI) and follow-up in each group were: CPE: 56.8 years (46 to 65); 30.7 kg/m(2) (19 to 58); 13.2 years (2.1 to 14.7) and HXLPE: 55.6 years (45 to 65); BMI: 30 kg/m(2) (18 to 51); 13.1 years (5.7 to 14.4).
  
  
  RESULTS
  The mean Harris hip score (HHS) at final follow-up was 89.3 for the CPE group and 90.9 for the HXLPE group (p = 0.078). Osteolysis was present around 15 acetabular (17%) and 16 femoral (18%) components in the CPE hips compared with none (0%) in the HXLPE hips. The mean radiological linear wear of the CPE liners was 0.11 mm/year compared with 0.035 mm/year for the HXLPE liners (p = 0.006). The cumulative implant survival, with revision for polyethylene wear as the endpoint, was 86% (95% confidence interval 78 to 94) in the CPE group and 100% in the HXLPE group at 13 years (numbers at risk at 13 years - CPE: 65, XLPE: 61).
  
  
  CONCLUSIONS
  This study shows that HXLPE liners are associated with significantly less osteolysis and a lower rate of revision THA than CPE liners at long-term follow-up.
  
  
  CONCLUSIONS
  The findings of this study highlight the clinical benefits of using HXLPE liners in THA and support the routine use of the material in order to improve implant longevity and to decrease the number of patients needing revision for aseptic osteolysis.
authors.affiliation: University of Western Ontario, London, Ontario, N6G 2V4, Canada.
authors.forename: S A
authors.initials: SA
authors.lastname: Hanna
authors.affiliation: University of Western Ontario, London, Ontario, N6G 2V4, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Somerville
authors.affiliation: University of Western Ontario, London, Ontario, N6G 2V4, Canada.
authors.forename: R W
authors.initials: RW
authors.lastname: McCalden
authors.affiliation: University of Western Ontario, London, Ontario, N6G 2V4, Canada.
authors.forename: D D
authors.initials: DD
authors.lastname: Naudie
authors.affiliation: University of Western Ontario, London, Ontario, N6G 2V4, Canada.
authors.forename: S J
authors.initials: SJ
authors.lastname: MacDonald
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D003432:Cross-Linking Reagents / Q000627:therapeutic use; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D010014:Osteolysis / Q000209:etiology; D020959:Polyethylene / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data
chemical_list: D003432:Cross-Linking Reagents; D020959:Polyethylene
keywords: Conventional; Cross-Linked; Polyethylene; Revision; Total Hip Arthroplasty (THA); Wear