Cross-Linked Implants Reduce Revision Surgery Rates

A long-term follow-up study confirms that hip implants made of cross-linked polyethylene (XLPE) substantially lower the risk of revision surgery after total hip replacement.

Researchers at the South Australian Health and Medical Research Institute (SAHMRI; Adelaide, Australia) and the University of Adelaide (UA; Australia) conducted an observational study of all patients who underwent THA for osteoarthritis (OA) in Australia from 1999 through December 31, 2016, in order to compare total hip arthroplasty (THA) revision surgery rates between patients that received XLPE implants and those that received conventional non-cross-linked polyethylene (CPE) at 16 years follow up.

The data, extracted from the Australian Orthopaedic Association (Sydney, Australia) national joint replacement registry, revealed that CPE was used in 41,171 procedures, and XLPE was used in 199,131; men and women who received XLPE implants were slightly younger than those that underwent CPE. XLPE implants were associated with a lower rate of revision at six months, with the difference becoming more apparent over time. The 16-year cumulative percentage of revisions of primary THAs was 11.7% in the CPE group and 6.2% in the XLPE group.

After adjustment for other risk factors, patients with CPE implants were about three times more likely to have revision surgery after nine years, compared to those with XLPE implants. At seven years, younger patients with CPE hip prostheses were about five times more likely to need revision surgery. Revisions directly related to wear of the bearing surface occurred in 0.81% of procedures that used CPE, compared to just 0.05% of procedures that used XLPE. The study was published on August 1, 2018, in The Journal of Bone & Joint Surgery.

“Wear-related and implant-longevity issues are particularly important in younger patients, who are generally more active and have a longer life span than their older counterparts,” concluded Professor Richard de Steiger, MD, of SAHMRI, and colleagues. “We believe that the evidence of reduced long-term wear with XLPE is now so strong that, when a polyethylene bearing surface is used in THA, it should be XLPE, particularly in younger patients."

THA is one of the most effective surgical procedures for the management of hip OA. The most common bearing surface for THA has been conventional CPE, which has been in use for over 50 years. As limiting wear of the bearing surface is critical to long-term success, particularly for younger patients, research has led to the development of XLPE, which has improved wear characteristics.

Related Links:
South Australian Health and Medical Research Institute
University of Adelaide
Australian Orthopaedic Association