Superior Wear Resistance of Highly Cross-Linked Cemented Polyethylene Cups in Young Patients: A Randomized Controlled...

Polyethylene wear of the acetabular component is related to periprosthetic osteolysis and subsequent aseptic loosening, requiring revision surgery. Highly cross-linked polyethylenes (HXLPEs) have been developed to mitigate wear. However, long-term randomized comparative studies focusing on acetabular component wear in young patients are scarce. Therefore, this study aimed to assess the 10-year polyethylene wear of cemented HXLPE compared to conventional polyethylene (CPE) cups in patients below 50 year old undergoing primary total hip arthroplasty (THA).

A single-blinded randomized controlled trial was developed. Inclusion criteria were primary THA below the age of 50 years. Exclusion criteria were THA due to an oncologic disease. Primary outcome measures were linear and volumetric wear. Secondary outcome measures were osteolysis, acetabular component survival, and postoperative complications. Wear outcomes were assessed by comparing baseline and 10-year postoperative radiographs. There were 54 patients who had 56 hips (27 HXLPE and 29 CPE) included in the final analysis. The mean follow-up was 10.7 years (range, 9.0 to 12.3). The mean age at surgery was 36 years (range, 17 to 49).

Linear wear rate was 0.037 mm/year (range, 0.02 to 0.07) for the HXLPE group and 0.109 mm/year (range, 0.04 to 0.25) for the CPE group. Volumetric wear rate was 13.7 mm³/year (range, two to 43) for the HXLPE group and 26.6 mm³/year (range, six to 88) for the CPE group. Progressive osteolysis was found exclusively in the CPE group (four hips). None of the cups were considered radiologically loose, and none of the cups were revised.

The HXLPE cemented acetabular cups demonstrate significantly reduced polyethylene wear rates compared to CPE cemented cups in young patients undergoing THA after 10 years of follow-up. However, longer follow-up is recommended to provide more comprehensive insights into implant longevity and fixation in these young THA patients.

Level I therapeutic study, randomized controlled trial.