Long-Term Wear-Related Complications of Cross-Linked Versus Conventional Polyethylene After Total Hip Arthroplasty: A Meta-Analysis

Byung Ho Yoon, Jung Wee Park, Young Kyun Lee, Kyung Hoi Koo, Chong Bum Chang

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish
Pages (from-to)2308-2315.e2
JournalJournal of Arthroplasty
Issue number11
StatePublished - Nov 2022

Bibliographical note

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.


  • cross-linked
  • hip arthroplasty
  • osteolysis
  • polyethylene
  • radiological wear
  • revision


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