JOA - 2026-04-24 - Journal Article
Excellent 20-Year Survivorship for Highly Cross-Linked Compared to Conventional Polyethylene in Total Hip Arthroplasty.
Jin W, Chen AG, Benaroch LR, Somerville L, Naudie DDR, MacDonald SJ, McCalden RW
Topics
Key Takeaway
At 20 years, HXLPE achieved 94% all-cause revision-free survivorship versus 65% for conventional polyethylene, with zero wear-related revisions in the HXLPE group (HR 0.184, p<0.001).
Summary Depth
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Summary
This study compared 20-year survivorship and clinical outcomes between HXLPE and CPE liners in patients under 65 undergoing primary THA with a 28mm cobalt-chromium head between 2000–2003. HXLPE demonstrated 94% vs 65% all-cause revision-free survivorship, 100% vs 77% wear-related revision-free survivorship, and 8-fold lower linear wear rate (0.029 vs 0.24 mm/year, p=0.007). Harris Hip Score and WOMAC scores were equivalent between groups at final follow-up.
Key Limitation
Retrospective non-randomized design with significant baseline age disparity between groups (CPE mean 59 vs HXLPE mean 53 years) was not fully adjusted for in survivorship analysis, potentially underestimating the true HXLPE benefit.
Original Abstract
INTRODUCTION
Highly cross-linked polyethylene (HXLPE) liners have demonstrated excellent wear resistance in total hip arthroplasty (THA). However, there is limited long-term data directly comparing outcomes between HXLPE and conventional polyethylene (CPE) liners. This study compared the 20-year implant survivorship and clinical outcomes in patients who underwent THA using HXLPE or CPE.
METHODS
A retrospective review was performed for patients under 65 years of age who underwent a primary THA at our institution between January 2000 and December 2003, using a CPE or HXLPE liner and a 28 mm cobalt-chromium femoral head. We identified 331 hips in 282 patients: 117 hips received CPE liners and 214 received HXLPE liners. The mean age, body mass index (BMI), and follow-up were 59 years, 31, and 18 years in the CPE group and 53 years, 31, and 17 years in the HXLPE group, respectively.
RESULTS
At 20 years, survivorship free from all-cause revision was 94% for HXLPE and 65% for CPE; for polyethylene wear-related revision, survivorship was 100% for HXLPE and 77% for CPE. The HXLPE group had a significantly lower hazard of all-cause revision compared to CPE (hazard ratio (HR) = 0.184, P < 0.001), indicating patients who received CPE were five times more likely to undergo revision. For polyethylene wear-related revision, no events were observed in the HXLPE group, resulting in a significantly lower risk compared to CPE (HR = 0.006, P = 0.014). The mean linear wear was significantly lower in the HXLPE liners (0.029 versus 0.24 mm/year, P = 0.007). At final follow-up, no significant differences were found between the two groups for both the Harris Hip Score (HHS) (HXLPE: 89 versus
CPE
91.5) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (HXLPE: 71.3 versus
CPE
75.4).
CONCLUSION
At 20-year follow-up, HXLPE had significantly improved survivorship compared to CPE, with no wear-related revisions in the HXLPE group. These findings support the long-term durability of HXLPE in THA.