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Increase in early polyethylene wear after sterilization with ethylene oxide: radiostereometric analyses of 201 total hips.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
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2003 (English)In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 74, no 5, 531-541 p.Article in journal (Refereed) Published
Abstract [en]

We evaluated polyethylene wear by measuring femoral head penetration in 201 THA (median age 62 (31-81) years, 117 women) extracted from 5 randomized studies aimed to assess various fixation principles. There were 30 cemented all-polyethylene Lubinus cups sterilized by gamma irradiation in a reduced oxygen environment, 65 porous-coated Trilogy cups with liners gamma-sterilized in inert gas. Moreover, 37 cemented cups were sterilized with ethylene oxide (Reflection all-poly) and 69 porous-coated cups had liners sterilized in ethylene oxide (Reflection). 28 mm femoral heads were used in all cups. The patients were followed with repeated radiostereometric measurements (RSA) up to 2 years. The activity level of the patients was evaluated by a questionnaire. After 2 years, cups with polyethylene sterilized in EtO had almost twice the proximal and 3D penetration rates, as compared with gamma-sterilized polyethylene. The penetration did not differ between the gamma-irradiated designs. Using stepwise linear regression analysis, we found that the type of sterilization, age and weight were the most important predictors and that they determined the direction of the proximal penetration rate. Activity score, male gender and proximal migration of the cup had little effect. The accelerated wear observed with the EtO-sterilized polyethylene causes concerns about long-term problems and especially in younger patients.

Place, publisher, year, edition, pages
2003. Vol. 74, no 5, 531-541 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:umu:diva-3864DOI: 10.1080/00016470310017910PubMedID: 14620972OAI: diva2:142752
Available from: 2004-04-13 Created: 2004-04-13 Last updated: 2010-08-11Bibliographically approved
In thesis
1. Wear and Fixation of the acetabular component: in vivo evaluation of different polyethylenes and modes of fixation in total hip arthroplasty
Open this publication in new window or tab >>Wear and Fixation of the acetabular component: in vivo evaluation of different polyethylenes and modes of fixation in total hip arthroplasty
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[de]
Verschleiβ und Verankerung der Pfanne von Hüftendoprothesen : In vivo Beurteilung von unterschiedlichen Polyethylenen und Fixationsarten
Abstract [en]

Polyethylene wear and micromotion of the implant play an important role in multifactorial etiology of osteolysis leading to aseptic loosening of the acetabular components. Despite excellent results in primary total hip arthoplasty in a 10-15 year perspective there are still unsolved problems. The weakest link is the longevity of the actabular component. Young and active patients have a clearly worse outcome than older patients. Consequences of polyehtylene wear and ways to reduce wear have therefore been in focus during recent years. Radiostereometry (RSA) is the golden standard in measuring in vivo micromotions. In 4 clinical studies including 332 patients we used therefore RSA to record the efficacy of fixation of cemented and uncemented cups. The amount of wear of old and newly designed polyethylenes (PE) was related to cup stability and radiological and clinical measures of outcome.

This study showed that cementless cups inserted with pressfit technique do not need additional augmentation. Screws and pegs increase the risk for radiolucencies and osteolystic lesions but are helpful tools in cases where primary stability is jeopardized. In the second decade clinically silent osteolysis is common for the porous coated Harris Galante cup with unsealed screw holes. The locking mechanism of the PE liner in this cup is unsatisfactory and an increase of liner dissociations is expected. EtO sterilized PE displayed high in vivo wear and we do not recommend its continued use but close monitoring of patients with earlier inserted EtO sterilized implants. The substantially reduced wear in cemented highly cross-linked PE cups without any negative in vivo tradeoffs might have a substantial impact on choice of material and operating technique in the near future. However, we still recommend its restrained use in controlled series until longer follow-up data is available. Nevertheless, the short term in vivo results of modern highly cross-linked PE look promising and ight improve the outcome of cemented and uncemented hip arthroplasties by reducing complication and revisions.

150 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 879
Surgery, total hip arthroplasty, acetabular component, wear, fixation, osteolysis, Radiostereometry, RSA, Kirurgi
National Category
Research subject
urn:nbn:se:umu:diva-230 (URN)91-7305-614-6 (ISBN)
Public defence
2004-04-29, Betula Sal, 6M, Norrlands Universitetssjukhus, 901 85 Umeå, 13:00
Available from: 2004-04-13 Created: 2004-04-13 Last updated: 2010-08-11Bibliographically approved

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Röhrl, Stephan
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