Hip resurfacing arthroplasty with cemented highly cross-linked all polyethylene acetabular components

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Arthroplasty Research

Background:

• Hip resurfacing arthroplasty (HRA) is indicated for specific patient groups not well-served by total hip replacement (THR).
• Historically, Metal-on-Metal (MoM) bearings dominated HRA but are now discontinued due to concerns over metal wear debris.
• Highly cross-linked polyethylene (XLPE) bearings have demonstrated excellent outcomes in THR.

Purpose of the Study:

• To evaluate the efficacy and survivorship of cemented highly cross-linked polyethylene (XLPE) acetabular bearings in hip resurfacing arthroplasty (HRA).
• To assess the wear characteristics and clinical outcomes of XLPE bearings in HRA over a long-term follow-up period.

Main Methods:

• A prospective cohort study involving 122 patients undergoing HRA with cemented XLPE acetabular components.
• Patients were followed for a mean of 15 years (range 10-20 years), with clinical outcomes and survivorship meticulously recorded.
• Analysis of retrieved implants (revision or postmortem) was conducted to assess wear debris and implant consequences.

Main Results:

• The 10-year all-cause revision survival rate was 93.5% (95% CI: 91.7-98.1%).
• Six acetabular bearings (4.9%) required revision due to loosening (2), polyethylene wear (2), or dislocation (2).
• Implant retrieval analysis revealed limited anterior/superior wear in most cases, with minimal wear in the dome; two implants showed no signs of wear.

Conclusions:

• Cemented XLPE acetabular bearings demonstrate successful initial clinical outcomes in HRA.
• While effective, cemented XLPE does not offer screw fixation options, limiting its applicability in all HRA cases.
• The study supports cemented XLPE as a reasonable approach for HRA, acknowledging its limitations compared to metal-backed components.