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Does vitamin E-blended polyethylene reduce wear in primary total hip arthroplasty: a blinded randomised clinical trial

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Abstract

Purpose

Some data indicate that first-generation highly cross-linked polyethylene (HXLPE) can oxidise in vivo and is associated with reduced mechanical properties. To overcome these limitations, a natural anti-oxidant vitamin E has been added to HXLPE to preserve the mechanical properties and decrease oxidative degradation whilst conserving high wear resistance. We hypothesised that after a minimal three years of follow-up the use of vitamin E-blended HXLPE would result in lower radiographic wear when compared with ultra-high molecular weight polyethylene (UHMWPE).

Methods

One hundred patients were randomised to receive hybrid total hip arthroplasty (THA) using a monoblock cementless acetabular component made either of UHMWPE or vitamin E-blended HXLPE. All other parameters were identical in both groups. Complete follow-up was available for 74 of these patients. Femoral head penetration was measured using a validated computer-assisted method.

Results

The median creep measured 0.111 mm (range, −0.576 – +0.444 mm) in the vitamin E-blended group versus 0.170 mm (range, −0.861 – +0.884 mm) in the UHMWPE group (difference of medians, 0.059; p = 0.046). The median steady state penetration rate was −0.008 mm/year (range, −0.88 – +0.64 mm/year) in the vitamin E-blended group versus 0.133 mm/year (range, −0.84 – +0.85 mm/year) in the UHMWPE group (difference of medians 0.141, p = 0.043).

Conclusions

This study demonstrated that femoral head penetration was lower when using vitamin E-blended HXLPE when compared with UHMWPE, with a steady-state penetration rate far below the osteolysis threshold. Longer-term follow-up is needed to warrant whether wear reduction will generate less occurrence of osteolysis and aseptic loosening.

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Authors and Affiliations

  1. Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Center, Centre Hospitalo-Universitaire Pitié Salpétrière, 83 boulevard de l’hôpital, 75013, Paris, France

    Caroline Scemama

  2. Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Centre, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France

    Philippe Anract, Valérie Dumaine, Antoine Babinet, Jean Pierre Courpied & Moussa Hamadouche

Authors
  1. Caroline Scemama
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  2. Philippe Anract
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  3. Valérie Dumaine
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  4. Antoine Babinet
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  5. Jean Pierre Courpied
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  6. Moussa Hamadouche
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Corresponding author

Correspondence to Caroline Scemama.

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Conflict of interest

One of the authors, or a member of his or her immediate family, has or may receive payments or benefits, during the study period, of an amount less than US$ 10,000, from Mahys AG (Bettlach, Switzerland)

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There is no funding source

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This article does not contain any studies with human participants or animals performed by any of the authors

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Informed consent was obtained from all individual participants included in the study

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Level I therapeutic study

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Scemama, C., Anract, P., Dumaine, V. et al. Does vitamin E-blended polyethylene reduce wear in primary total hip arthroplasty: a blinded randomised clinical trial. International Orthopaedics (SICOT) 41, 1113–1118 (2017). https://doi.org/10.1007/s00264-016-3320-2

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