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Large Metal Heads and Highly Cross-Linked Polyethylene Provide Low Wear and Complications at 5-13 Years.

Publication ,  Journal Article
Lachiewicz, PF; O'Dell, JA; Martell, JM
Published in: J Arthroplasty
July 2018

BACKGROUND: Highly cross-linked polyethylene (XLPE) is reported to have low rates of linear and volumetric wear at 10-14 years. In a prior study, larger (36 and 40 mm) femoral heads were associated with more volumetric wear, but there were only 12 hips with these heads. METHODS: We evaluated 107 hips (93 patients, with a mean age of 76 years) with one design of uncemented acetabular component, a 36 (90 hips) or 40 mm (17 hips) metal femoral head, and one electron beam 100 kGy irradiated and remelted XLPE at a mean follow-up of 8 years (range 5-13 years). Selection of these femoral heads was based on several factors, including the perceived risk of dislocation, the outer diameter size of the acetabular component, and liner availability. Measurements of linear and volumetric wear were performed in one experienced laboratory by the Martell method and analyzed using the first-to-last method. Standard radiographs, with additional Judet views, were used to detect periprosthetic osteolysis. Clinical records were used to determine the complications of dislocation, liner fracture, and painful trunnion corrosion. RESULTS: For the entire cohort, the median linear wear rate was 0.041 mm/y (95% confidence interval, 0.031-0.057) and the median volumetric wear rate was 34.6 mm3/y (95% confidence interval, 31.4-53.5). With the numbers available, there was no difference in linear or volumetric wear between the 36 and 40 mm head sizes. Small, asymptomatic osteolytic lesions were noted in 3 hips (2%). There were 3 patients (3%) with dislocation (2 early and 1 late), but these have not had a revision. There were no revisions for loosening, no liner fracture, and no patient with symptomatic trunnion corrosion. CONCLUSION: This acetabular component and XLPE with large metal heads had low rates of linear and volumetric wear. Large metal femoral heads did not lead to liner fracture, loosening, or symptomatic trunnion corrosion in this patient population. However, we recommend longer clinical follow-up studies and caution in the routine use of larger metal femoral heads in other, younger patient populations.

Duke Scholars

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

July 2018

Volume

33

Issue

7

Start / End Page

2187 / 2191

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Radiography
  • Prosthesis Failure
  • Prosthesis Design
  • Polyethylene
  • Osteolysis
  • Orthopedics
  • Middle Aged
 

Citation

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ICMJE
MLA
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Lachiewicz, P. F., O’Dell, J. A., & Martell, J. M. (2018). Large Metal Heads and Highly Cross-Linked Polyethylene Provide Low Wear and Complications at 5-13 Years. J Arthroplasty, 33(7), 2187–2191. https://doi.org/10.1016/j.arth.2018.02.063
Lachiewicz, Paul F., Jane A. O’Dell, and John M. Martell. “Large Metal Heads and Highly Cross-Linked Polyethylene Provide Low Wear and Complications at 5-13 Years.J Arthroplasty 33, no. 7 (July 2018): 2187–91. https://doi.org/10.1016/j.arth.2018.02.063.
Lachiewicz PF, O’Dell JA, Martell JM. Large Metal Heads and Highly Cross-Linked Polyethylene Provide Low Wear and Complications at 5-13 Years. J Arthroplasty. 2018 Jul;33(7):2187–91.
Lachiewicz, Paul F., et al. “Large Metal Heads and Highly Cross-Linked Polyethylene Provide Low Wear and Complications at 5-13 Years.J Arthroplasty, vol. 33, no. 7, July 2018, pp. 2187–91. Pubmed, doi:10.1016/j.arth.2018.02.063.
Lachiewicz PF, O’Dell JA, Martell JM. Large Metal Heads and Highly Cross-Linked Polyethylene Provide Low Wear and Complications at 5-13 Years. J Arthroplasty. 2018 Jul;33(7):2187–2191.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

July 2018

Volume

33

Issue

7

Start / End Page

2187 / 2191

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Radiography
  • Prosthesis Failure
  • Prosthesis Design
  • Polyethylene
  • Osteolysis
  • Orthopedics
  • Middle Aged