Clinical Performance of a Durasul Highly Cross-Linked Polyethylene Acetabular Liner for Total Hip Arthroplasty at Five Years

Background: Highly cross-linked polyethylene is currently the most common articulation surface used for total hip arthroplasty. The hypothesis of the present study was that the Durasul highly cross-linked polyethylene acetabular liner would have less wear at five years than would a conventional polyethylene liner used in association with the same total hip replacement system.

Methods: Forty-three consecutive patients (fifty hips) underwent total hip replacement with an uncemented titanium porous-coated metal cup and a Durasul liner that was mated with a 28-mm cobalt-chromium femoral head. Thirty-one patients (thirty-seven hips) were followed for at least five years. Thirty-five other patients (thirty-seven hips) underwent total hip arthroplasty with the same system but with a conventional polyethylene liner, and these patients also were followed for five years. Clinical assessment was performed with use of the Harris hip score and a patient self-assessment examination. Radiographic analysis included measurements of acetabular component position, fixation, and osteolysis. Femoral head penetration of the Durasul liners was compared with that of the conventional liners.

Results: The clinical results as determined on the basis of Harris hip scores and patient self-assessment examinations did not differ between the Durasul group and the control group. The mean bedding-in penetration was 0.054 ± 0.07 mm for the Durasul group and 0.059 ± 0.154 mm for the control group. The subsequent penetration, with elimination of the bedding-in wear, resulted in a linear wear rate of 0.029 ± 0.02 mm per year for the Durasul group, compared with 0.065 ± 0.03 mm per year for the control group (p < 0.005). The annual penetration at one and five years was 0.074 mm and 0.011 mm, respectively, for the Durasul group, compared with 0.151 mm and 0.04 mm, respectively, for the control group.

Conclusions: While the qualitative wear pattern of the highly cross-linked polyethylene liner was the same as that of the conventional polyethylene liner, the annual linear wear rate was 45% of that seen with the conventional polyethylene liner. Therefore, we believe that these early data support the continued use of this highly cross-linked polyethylene liner for total hip arthroplasty.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.