Abstract

Highly cross-linked polyethylene (HXPLE) acetabular bearing surfaces have appeared to offer excellent wear resistance, low incidence of wear-related osteolysis, and high implant survivorship at 10- to 15-year follow-ups. However, concerns over potential performance deterioration at longer-term follow-up remain - particularly in younger patients - and outcome data into the third decade have not been available.We retrospectively assessed 62 patients (68 hips) who underwent primary total hip arthroplasty (THA) at age =50 years with a single manufacturer's cementless components, remelted HXLPE liner, and small diameter (26 and 28 millimeter) cobalt-chromium (CoCr) femoral heads at minimum 18-year follow-up. We assessed clinical outcomes (modified Harris Hip score, UCLA (University of California Los Angeles Activity Score), polyethylene wear rates, radiographic findings (osteolysis, component loosening), and implant survivorship.At 20.6-year mean follow-up (range, 18 to 23 years) modified Harris Hip scores for surviving hips remained an average of 41 points above preoperative baseline (49 vs. 90, P<0.001) and UCLA scores 2.8 points above baseline (3.7 vs. 6.4, P<0.001). Wear analysis revealed a population linear wear rate of 0.0142 mm/year (Standard deviation (SD), 0.0471) and volumetric wear rate of 10.14 mm3/year (SD, 23.41). Acetabular lysis was noted in two asymptomatic hips at 16.6 and 18.4 years. No components were radiographically loose. Survivorship free from wear-related revision was 100% at 20 years (97% [95% Confidence Interval (CI), 86.9-99.1%] free from any revision).At 20-year follow-up, HXLPE bearings in this young cohort retained excellent wear characteristics. The HXLPE-CoCr bearing couple with small femoral heads continues to be extremely effective 20 years after primary THA in the younger patient population.

View details for DOI 10.1016/j.arth.2023.08.025

View details for PubMedID 37572728