TY - JOUR
T1 - Long-Term Wear-Related Complications of Cross-Linked Versus Conventional Polyethylene After Total Hip Arthroplasty
T2 - A Meta-Analysis
AU - Yoon, Byung Ho
AU - Park, Jung Wee
AU - Lee, Young Kyun
AU - Koo, Kyung Hoi
AU - Chang, Chong Bum
N1 - Funding Information:
Funding: This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT , the Ministry of Trade, Industry and Energy , the Ministry of Health & Welfare , and the Ministry of Food and Drug Safety ) (Project Number: RS-2020-KD000038 ).
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/11
Y1 - 2022/11
N2 - Background: Highly cross-linked polyethylene (HXLPE) liners have been developed to address the wear-related problems associated with conventional polyethylene (CPE) such as osteolysis or aseptic loosening in total hip arthroplasty (THA). In this systematic meta-analysis, we compared the long-term efficacy in preventing radiological osteolysis and revision surgery between HXLPE and CPE. Methods: We included 14 studies that compared HXLPE and CPE reporting the incidence of wear-related complications with a minimum follow-up of 10 years. We investigated 5 wear-related complications: osteolysis, excessive wear, linear wear rate, revision surgery due to wear, and progress of osteolysis/aseptic loosening. We conducted a pair-wise meta-analysis to estimate odds ratio (OR) and a proportional meta-analysis to estimate the incidence of each complication. Results: Among 1,175 THAs, 220 osteolysis and 78 wear-related revisions were detected. The use of HXLPE reduced the risk of overall osteolysis (OR 0.30; P = .001), excessive wear (OR 0.10; P < .001), linear wear rate (weighted mean difference 0.09; P < .001), the risk of overall wear-related revisions (OR 0.06; P < .001), and revisions due to aseptic loosening (OR 0.23; P = .015). As per the proportional meta-analysis, the pooled prevalence of osteolysis, excessive wear, and the overall wear-related revision rate were 14%, 8%, and 3% in HXLPE and 25%, 33%, and 20% in CPE, respectively. Conclusion: The current evidence shows that HXLPE dramatically reduced the rate of osteolysis and wear-related revision surgery. However, as polyethylene wear and osteolysis still lead to revision surgery, ongoing clinical and retrieval studies are required to analyze long-term outcomes.
AB - Background: Highly cross-linked polyethylene (HXLPE) liners have been developed to address the wear-related problems associated with conventional polyethylene (CPE) such as osteolysis or aseptic loosening in total hip arthroplasty (THA). In this systematic meta-analysis, we compared the long-term efficacy in preventing radiological osteolysis and revision surgery between HXLPE and CPE. Methods: We included 14 studies that compared HXLPE and CPE reporting the incidence of wear-related complications with a minimum follow-up of 10 years. We investigated 5 wear-related complications: osteolysis, excessive wear, linear wear rate, revision surgery due to wear, and progress of osteolysis/aseptic loosening. We conducted a pair-wise meta-analysis to estimate odds ratio (OR) and a proportional meta-analysis to estimate the incidence of each complication. Results: Among 1,175 THAs, 220 osteolysis and 78 wear-related revisions were detected. The use of HXLPE reduced the risk of overall osteolysis (OR 0.30; P = .001), excessive wear (OR 0.10; P < .001), linear wear rate (weighted mean difference 0.09; P < .001), the risk of overall wear-related revisions (OR 0.06; P < .001), and revisions due to aseptic loosening (OR 0.23; P = .015). As per the proportional meta-analysis, the pooled prevalence of osteolysis, excessive wear, and the overall wear-related revision rate were 14%, 8%, and 3% in HXLPE and 25%, 33%, and 20% in CPE, respectively. Conclusion: The current evidence shows that HXLPE dramatically reduced the rate of osteolysis and wear-related revision surgery. However, as polyethylene wear and osteolysis still lead to revision surgery, ongoing clinical and retrieval studies are required to analyze long-term outcomes.
KW - cross-linked
KW - hip arthroplasty
KW - osteolysis
KW - polyethylene
KW - radiological wear
KW - revision
UR - http://www.scopus.com/inward/record.url?scp=85131517398&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2022.05.013
DO - 10.1016/j.arth.2022.05.013
M3 - Article
C2 - 35568139
AN - SCOPUS:85131517398
VL - 37
SP - 2308-2315.e2
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
SN - 0883-5403
IS - 11
ER -