Cross-Linked Polyethylene for Total Hip Arthroplasty Markedly Reduces Revision Surgery at 16 Years

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Cross-Linked Polyethylene for Total Hip Arthroplasty Markedly Reduces Revision Surgery at 16 Years
Key Take-Away: 

Total hip arthroplasty (THA) is counted among the most effective and promising approach in medicine to provide relief from pain and to disability among patients with hip osteoarthritis. The intervention involves usage of polyethylene (PE) is the primary limiting factor to maintain its persistence. The study included evaluation more approaches to replace the PE for better outcomes.

Introduction
End-stage hip osteoarthritis management can be effectively done using total hip arthroplasty (THA), but long-term outcomes can't be achieved due to wearing by the polyethylene bearing surface. Lower wear rates and reduction in bone lysis are obtained by using cross-linking conventional polyethylene in both clinical and laboratory studies. The study aimed to compare the frequencies of revision within traditional non-cross-linked polyethylene (CPE) and cross-linked polyethylene (XLPE) at 16 years following THAs.

 

Methods
An observational study of conducted on the patients who went through THA in Australia between 1999 to December 31, 2016. The data related to the patients for the analysis were selected from a national registry. A comparison of outcomes of XLPE with CPE, along with an investigation of the effect of sex, age, the method of acetabular and femoral component fixation, reasons and types of revision and femoral head size were conducted. The time to the first revision was the principal outcome which measured applying Kaplan-Meier estimates of survivorship.

 

Results
A total of 199,131 procedures involved XLPE and 41,171 were CPE. The CPE involved men and women of 70.0 and 72.5 years respectively, and XLPE involved men and women of 68.6 and 72.5 years respectively. The CPE was associated with a higher rate of revision than XLPE at six months, and the difference became more apparent with time. CPE and XLPE group exhibited 16-year cumulative percentage 11.7% and 6.2% of revisions of the primary THAs, respectively. The hazard ratio noticed after nine years were 3.02 (p = 0.001).

 

Conclusions
A significant reduction in the percentage of revision was noticed after the use of XLPE at 16 years after THA. This proposes that the persistence of THA is expected to be improved. This evidence suggests that the persistence of THA is likely to be improved, which may allow younger patients to go through the surgery, assured of a decreased requirement for revision in the long term.

Source:

The Journal of Bone and Joint Surgery

Link to the source:

https://insights.ovid.com/pubmed?pmid=30063590

Original title of article:

Cross-Linked Polyethylene for Total Hip Arthroplasty Markedly Reduces Revision Surgery at 16 Years.

Authors:

R. de Steiger et al.

Therapeutic, Hip Osteoarthritis, Hip Joints, Observational Study, Efficacy
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