Cross-linked versus conventional polyethylene for total hip replacement: A META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

• Published in: Journal of bone and joint surgery. British volume Vol. 93; no. 5; pp. 593 - 600
• Main Authors: KUZYK, P. R. T, SACCONE, M, SPRAGUE, S, SIMUNOVIC, N, BHANDARI, M, SCHEMITSCH, E. H
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01-05-2011
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - instrumentation; Biological and medical sciences; Diseases of the osteoarticular system; Female; Hip Prosthesis; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Polyethylene - chemistry; Prosthesis Design; Prosthesis Failure; Randomized Controlled Trials as Topic; Research Design; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Hip prosthesis; Polyethylene; Orthopedic surgery; Treatment; Crosslinked polymer; Comparative study; Hip
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.93B5.25908

We conducted a systematic review and meta-analysis of randomised controlled trials comparing cross-linked with conventional polyethylene liners for total hip replacement in order to determine whether these liners reduce rates of wear, radiological evidence of osteolysis and the need for revision. The MEDLINE, EMBASE and COCHRANE databases were searched from their inception to May 2010 for all trials involving the use of cross-linked polyethylene in total hip replacement. Eligibility for inclusion in the review included the random allocation of treatments, the use of cross-linked and conventional polyethylene, and radiological wear as an outcome measure. The pooled mean differences were calculated for bedding-in, linear wear rate, three-dimensional linear wear rate, volumetric wear rate and total linear wear. Pooled risk ratios were calculated for radiological osteolysis and revision hip replacement. A search of the literature identified 194 potential studies, of which 12 met the inclusion criteria. All reported a significant reduction in radiological wear for cross-linked polyethylene. The pooled mean differences for linear rate of wear, three-dimensional linear rate of wear, volumetric wear rate and total linear wear were all significantly reduced for cross-linked polyethylene. The risk ratio for radiological osteolysis was 0.40 (95% confidence interval 0.27 to 0.58; I(2) = 0%), favouring cross-linked polyethylene. The follow-up was not long enough to show a difference in the need for revision surgery.