Highly Crosslinked Polyethylene Improves Wear But Not Surface Damage in Retrieved Acetabular Liners
Highly Crosslinked Polyethylene Improves Wear But Not Surface Damage in Retrieved Acetabular Liners
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DOI：
10.1007/s11999-014-3858-5
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发表时间：
2015-02-01
影响因子：
4.2
通讯作者：
Teeter, Matthew G.
中科院分区：
文献类型：
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作者：
Pang, Hee-Nee;Naudie, Douglas D. R.;Teeter, Matthew G.
高交联聚乙烯（XLPE）被认为在全髋关节置换术中比传统聚乙烯（CPE）具有更好的耐磨性。本研究的目的是比较匹配的XLPE和CPE髋臼衬垫之间的视觉损伤评分和微ct穿透测量（磨损的替代指标）。13例XLPE髋臼衬套在植入物设计（均为相同设计）、患者年龄、性别、衬套尺寸、植入时间和翻修原因方面进行匹配，并在同一时间段内取出一组CPE衬套。用micro-CT测量了两组衬套磨损和蠕变共同作用下的侵彻量。两名盲法观察者使用表面损伤系统对表面损伤进行评分，该系统考虑了7种常见的损伤模式：点蚀、划伤、打磨、磨损、撞击、嵌入碎片和分层，并记录了磨损模式。XLPE组（14 +/- 4）与CPE组（15 +/- 5）的总损伤评分差异无统计学意义（p = 0.32）。然而，CPE组（0.18 +/- 0.09 mm/年）的穿透力是XLPE组（0.05 +/- 0.07 mm/年）的三倍（优势比为3.1；置信区间为2.3-5.1;p < 0.001）。与CPE组（350 +/- SD 342 mm）相比，XLPE组的体积损失更小（82 +/- SD 134 mm(3)）；P = 0.017)。根据微型ct提供的定量测量结果，XLPE尾管受蠕变和磨损的穿透程度比CPE尾管要小，而单独使用损伤评分并不明显。这证明了三维成像技术的使用，如微型ct在检索研究中量化磨损。在这项研究中，与CPE相比，XLPE的磨损更少，但损伤分数相似，这减轻了人们的担忧，即XLPE的有益磨损性能可能伴随着材料脆性增加而产生的权衡。
Highly crosslinked polyethylene (XLPE) is believed to demonstrate better wear resistance than conventional polyethylene (CPE) in total hip arthroplasty.The purpose of this study was to compare visual damage scores and micro-CT measurements of penetration, a surrogate for wear, between matched retrieved XLPE and CPE acetabular liners.Thirteen XLPE acetabular liners were matched in terms of implant design (all were of the same design), patient age, sex, liner dimensions, duration of implantation, and reason for revision to a group of CPE liners that were retrieved in the same time period. Penetration resulting from the combination of wear and creep in the two groups of liners was measured with micro-CT. Surface damage was scored by two blinded observers using a surface damage system that considers the seven common damage modes: pitting, scratching, burnishing, abrasions, impingement, embedded debris, and delamination, and wear patterns were documented.There was no difference (p = 0.32) in total damage score between the XLPE group (14 +/- 4) and the CPE group (15 +/- 5). However, there was three times greater penetration (odds ratio, 3.1; confidence interval, 2.3-5.1; p < 0.001) in the CPE group (0.18 +/- 0.09 mm/year) than in the XLPE group (0.05 +/- 0.07 mm/year). There was less volumetric loss in XLPE (82 +/- SD 134 mm(3)) versus the CPE group (350 +/- SD 342 mm(3); p = 0.017).XLPE liners undergo less penetration as a result of creep and wear than CPE liners based on quantitative measurements provided by micro-CT, which was not apparent using damage scoring alone. This demonstrates the use of three-dimensional imaging techniques such as micro-CT for quantifying wear in retrieval studies.In this study, XLPE had less wear but similar damage scores than CPE, allaying concerns that the beneficial wear properties of XLPE might come with a tradeoff arising from the increased brittleness of that material.