Highly Cross-Linked Polyethylene in Cementless Total Hip Arthroplasty in Patients with Previous Acetabular Fractures: A Minimum 5-Year Follow-Up Study

Abstract

Background: Outcomes of THA after acetabular fracture are generally less favorable than those of the nontraumatic arthritis due to a higher rate of cup loosening and osteolysis. We, therefore, investigated whether highly cross-linked polyethylene liners positively impact outcomes of THA in patients with posttraumatic osteoarthritis after acetabular fracture.

Methods: We retrospectively evaluated 39 patients with previous acetabular fracture who underwent THA using highly cross-linked polyethylene liner after a mean 8.5 year follow-up. All procedures were performed at a single institution by a single surgeon using the same type of THA implants. Wear measurements were performed using a computer-assisted PolyWare software. Osteolysis was evaluated with use of radiography and computed tomography.

Results: The mean preoperative Harris hip score was 44.4 points, which improved to 93.1 points at final follow-up. Neither femoral nor acetabular components displayed mechanical loosening and no components had been revised. Radiographs and CT scans did not demonstrate osteolysis. The mean linear wear was 0.043 mm/y (range 0-0.098 mm/y). With the data available, univariate regression analysis suggests that age, gender, weight, initial fracture type, the duration of follow-up, activity level, liner thickness, acetabular cup inclination, and the necessity of bone graft had no influence on liner penetration.

Conclusion: While the long-term effects of the polyethylene particles from highly cross-linked polyethylene remain unknown, implant survivorship and wear data in this study are promising for this high-risk population. Our encouraging results support the continued use of this type of polyethylene in patients after acetabular fractures.

Level of evidence: Level IV Therapeutic study.