Five-year experience with Crossfire (R) highly cross-linked polyethylene
ABSTRACT Our purpose was to compare the clinical wear performance of highly cross-linked (Crossfire) polyethylene with conventional (N2Vac) polyethylene total hip bearings. We implanted 56 hips (47 patients) with Crossfire acetabular bearing liners and compared their wear performance with 53 conventional polyethylene inserts. Wear and clinical data were collected retrospectively at a minimum 4-year and average 5-year followup. The linear femoral head penetration rate measured from plain radiographs was 0.055 mm/year +/- 0.022 mm/year for the Crossfire polyethylene and 0.138 mm/year +/- 0.073 mm/year for the control, a reduction of 60% for the Crossfire components. Calculated annual wear was 0.036 mm/year for the Crossfire components and 0.131 mm/year for the controls, a reduction of 72%. Radiographic review at most recent followup showed a reduction in erosive osteolytic lesions of the proximal femur for the Crossfire components compared with controls, also suggesting a reduction in debris release for the Crossfire components. Complications leading to revision were not seen in the Crossfire or control groups. These clinical findings suggest that this particular highly cross-linked polyethylene can provide wear reduction and an alternate bearing surface for active patient populations. Level of Evidence: Therapeutic study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
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ABSTRACT: Ceramic bearings were introduced to reduce wear and increase long-term survivorship of total hip arthroplasty. In a previous study comparing ceramic with metal-on-polyethylene at 5 to 8 years, we found higher survivorship and no osteolysis for the ceramic bearings. We asked whether ceramic bearings have equal or superior survivorship compared with that for metal-on-polyethylene at longer followup; we also determined survivorship of the implant systems, the presence or absence of radiographic osteolysis, and incidence of device squeaking. Five surgeons at five sites have followed 189 patients (216 hips) for a minimum of 10 years and average of 10.3 years (range, 10-12.4 years) comparing alumina ceramic bearings (144 hips) with cobalt chrome-on-polyethylene bearings (72 hips). We determined Kaplan-Meier survivorship of the bearing surface and implant systems and collected radiographic and clinical data. We observed no difference between the control metal-on-polyethylene and the alumina-bearing couple cohorts with regard to bearing-related failures (98.9% versus 99.1%). Revisions for any reason occurred in 10.5% of the control patients and 3.1% of the patients with alumina bearings. All femoral implants remain well fixed (100%), whereas one acetabular component (1%) is unstable in the control group. Osteolysis occurred in 26% of the control patients and in none of the patients with alumina bearings. Squeaking occurred in two of 144 hips (1.4%) of the patients with ceramic bearings. Patients receiving the ceramic-on-ceramic bearings had fewer revisions for any reason and less osteolysis than the control metal-on-polyethylene at 10 years. Our data suggest ceramic bearings continue to provide an option for the young and more active patient and provide for a measure to compare other new alternative bearings that are currently available. Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 02/2011; 470(2):373-381. DOI:10.1007/s11999-011-2076-7
Article: Learning Objectives Upon completion of this activity, participants should be able to: 1. Understand the indications and known methods for the use of each of the alternative bearings over conventional polyethylene. 2. Describe the major disadvantages or potential risks with the use of the new alternative bearings when compared with conventional polyethylene