Does vitamin E-blended polyethylene reduce wear in primary total hip arthroplasty: a blinded randomised clinical trial.
Some data indicate that first-generation highly cross-linked polyethylene (HXLPE) can oxidise in vivo and is associated with reduced mechanical properties. To overcome these limitations, a natural anti-oxidant vitamin E has been added to HXLPE to preserve the mechanical properties and decrease oxidative degradation whilst conserving high wear resistance. We hypothesised that after a minimal three years of follow-up the use of vitamin E-blended HXLPE would result in lower radiographic wear when compared with ultra-high molecular weight polyethylene (UHMWPE).



One hundred patients were randomised to receive hybrid total hip arthroplasty (THA) using a monoblock cementless acetabular component made either of UHMWPE or vitamin E-blended HXLPE. All other parameters were identical in both groups. Complete follow-up was available for 74 of these patients. Femoral head penetration was measured using a validated computer-assisted method.



The median creep measured 0.111 mm (range, -0.576 - +0.444 mm) in the vitamin E-blended group versus 0.170 mm (range, -0.861 - +0.884 mm) in the UHMWPE group (difference of medians, 0.059; p = 0.046). The median steady state penetration rate was -0.008 mm/year (range, -0.88 - +0.64 mm/year) in the vitamin E-blended group versus 0.133 mm/year (range, -0.84 - +0.85 mm/year) in the UHMWPE group (difference of medians 0.141, p = 0.043).



This study demonstrated that femoral head penetration was lower when using vitamin E-blended HXLPE when compared with UHMWPE, with a steady-state penetration rate far below the osteolysis threshold. Longer-term follow-up is needed to warrant whether wear reduction will generate less occurrence of osteolysis and aseptic loosening.
Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Center, Centre Hospitalo-Universitaire Pitié Salpétrière, 83 boulevard de l'hôpital, 75013, Paris, France. scemamacaroline@gmail.com.
Caroline
C
Scemama
Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Centre, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France.
Philippe
P
Anract
Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Centre, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France.
Valérie
V
Dumaine
Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Centre, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France.
Antoine
A
Babinet
Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Centre, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France.
Jean Pierre
JP
Courpied
Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Centre, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France.
Moussa
M
Hamadouche
D000077:Acetabulum / Q000601:surgery; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005270:Femur Head / Q000601:surgery; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000601:surgery; D020959:Polyethylene / Q000009:adverse effects* / Q000627:therapeutic use; D011474:Prosthesis Design / Q000009:adverse effects / Q000379:methods*; D011475:Prosthesis Failure; D014810:Vitamin E / Q000627:therapeutic use*
D014810:Vitamin E; D020959:Polyethylene
HXLPE; Polyethylene; Total hip arthroplasty; UHMWPE; Vitamin E; Wear