Current Concepts Review   |    
Clinical Performance of Highly Cross-Linked Polyethylenes in Total Hip Arthroplasty
Cale A. Jacobs, PhD1; Christian P. Christensen, MD1; A. Seth Greenwald, DPhil(Oxon)2; Harry McKellop, PhD3
1 Lexington Clinic, 1221 South Broadway, Lexington, KY 40504. E-mail address for C.A. Jacobs: cjaco@lexclin.com
2 Orthopaedic Research Laboratories, Lutheran Hospital, 1730 West 25th Street, Cleveland, OH 44113
3 Department of Orthopaedic Surgery, University of California at Los Angeles Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (DePuy Orthopaedics and Biomet Orthopedics). Commercial entities (DePuy Orthopaedics, Biomet Orthopedics, and Smith and Nephew) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2007 Dec 01;89(12):2779-2786. doi: 10.2106/JBJS.G.00043
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Aseptic loosening secondary to wear-debris-induced osteolysis has been identified as the leading cause of late failure of total hip arthroplasty.

Highly cross-linked polyethylene acetabular liners were developed as one approach to reducing this wear.

Preclinical laboratory wear testing showed a number of cross-linked polyethylenes to have dramatically less wear than the polyethylene that had been in use for several decades.

After the initial bedding-in phase (one to two years), the percent reductions in the wear rate, as indicated by the amount of penetration of the head into the socket evident on serial radiographs, have been comparable with what was predicted from preclinical hip-simulator testing of the highly cross-linked polyethylenes.

To our knowledge, there have been no reports of clinically relevant osteolysis that was clearly attributable to wear of a highly cross-linked polyethylene acetabular liner. However, the clinical performance of these materials should be closely monitored with long-term follow-up.

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