van Loon J, Hoornenborg D, Sierevelt I, Opdam KT, Kerkhoffs GM, Haverkamp D. Highly cross-linked versus conventional polyethylene inserts in total hip arthroplasty, a five-year Roentgen stereophotogrammetric analysis randomised controlled trial. World J Orthop 2020; 11(10): 442-452 [PMID: 33134107 DOI: 10.5312/wjo.v11.i10.442]
Corresponding Author of This Article
Daniël Haverkamp, MD, PhD, Surgeon, Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, Amsterdam 1101EA, Netherlands. d.haverkamp@xpertorthopedie.nl
Research Domain of This Article
Orthopedics
Article-Type of This Article
Randomized Controlled Trial
Open-Access Policy of This Article
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World J Orthop. Oct 18, 2020; 11(10): 442-452 Published online Oct 18, 2020. doi: 10.5312/wjo.v11.i10.442
Table 1 Inclusion and exclusion criteria
Inclusion
Exclusion
Primary arthroplasty due to:
Patients who recently suffered:
Primary osteoarthritis
Post-operative osteoarthritis
Avascular necrosis
Charnley C osteoarthritis
Femoral neck fracture
Infection of the hip
Hip dysplasia
Age between 60 - 75 yr at surgery
Prior osteotomy or arthroplasty of the affected hip
Willing to comply with the post-operative review program
Under treatment for osteoporosis
Body mass index > 35 kg/m2
Requiring cortisone medication
Table 2 Patient and baseline characteristics
Conventional PE
REXPOL
Number of patients, n (%)
25 (49)
26 (51)
Gender, n (%)
Male
10 (40)
10 (39)
Female
15 (60)
16 (59)
BMI, mean ± SD kg/m2
26.7 ± 2.9
27.2 ± 3.4
Age at operation in years, mean ± SD
68.5 ± 4.6
68.6 ± 5.1
HOOS pain, mean ± SD
46.5 ± 21.6
51.1 ± 17.7
HOOS ADL, mean ± SD
41.1 ± 16.6
46.0 ± 17.2
HHS, mean ± SD
50.6 ± 12.7
54.6 ± 10.9
Table 3 Total wear in all directions at the five-year follow-up, presented as mean with ranges
Conventional PE (Polyethylene)
REXPOL
P value
Medial (mm)
-0.128 (-0.202 to -0.054)
0.013 (-0.054 to 0.081)
0.006
Proximal (mm)
0.196 (0.054 to 0.338)
0.017 (-0.120 to 0.154)
0.07
Volume (mm3)
113.39 (-2.48 to 229.26)
-30.59 (-167.16 to 105.98)
0.10
Corrected volume (mm3)
121.6 (17.76 to 225.46)
-12.45 (-122.94; 98.03)
0.07
Table 4 Mean wear rates per year, presented as mean with ranges
Conventional PE (Polyethylene)
P value
REXPOL
P value
Medial (mm/yr)
-0.021 (-0.028 to -0.015)
< 0.001
0.004 (-0.002 to 0.009)
0.21
Proximal (mm/yr)
0.033 (0.018 to 0.047)
< 0.001
0.003 (-0.011 to 0.017)
0.66
Volume (mm3/yr)
15.94 (2.729 to 29.15)
0.02
-5.545 (-20.36 to 9.269)
0.46
Corrected volume (mm3/yr)
18.53 (7.188 to 29.86)
0.002
-2.142 (-14.13 to 9.841)
0.72
Table 5 Functional outcomes at the five-year follow-up, presented as mean with 95%CI
Univariate
Multivariate
Conventional PE (n = 17)
REXPOL (n = 17)
P value
Adjusted β-coefficient
P value
HOOS pain
93.8 (86.8; 100)
85.9 (77.1; 94.7)
0.15
-3.3 (-14.9; 8.3)
0.57
HOOS ADL
89.0 (81.2: 96.8)
77.6 (66.6; 88.5)
0.08
-8.6 (-23.3; 6.1)
0.24
HHS
89.7 (83.0; 96.4)
86.5 (78.8; 94.2)
0.51
0.15 (-10.1; 10.4)
0.98
Citation: van Loon J, Hoornenborg D, Sierevelt I, Opdam KT, Kerkhoffs GM, Haverkamp D. Highly cross-linked versus conventional polyethylene inserts in total hip arthroplasty, a five-year Roentgen stereophotogrammetric analysis randomised controlled trial. World J Orthop 2020; 11(10): 442-452